IVF: An Emotional Companion

IVF: An Emotional Companion Brigid Moss IVF: An Emotional Companion is an invaluable, personal support, based on women's first hand experiences, for anyone struggling to conceive.Sharing the real life stories of 20 women who have worked their way through fertility and conception problems, this book is a lifeline for women and couples everywhere wanting to have a baby: an honest, inspirational and comforting read promising to help get you through the roller coaster that is fertility treatment.According to official figures, one in six couples have problems conceiving and more women than ever before are now considering in vitro fertilisation. It's not just physically taxing and expensive, but the emotional strain can at times be unbearable. Having to make lots of emotionally-charged decisions at every turn is tough: Should I push my GP to refer me for investigations? Are we ready for IVF? Should we try natural methods first? What shall we do now the treatment has failed?To help you work through these decisions, IVF: An Emotional Companion explains how others in similar situations have tackled these challenges and come through. ivf An Emotional Companion BRIGID MOSS Contents Cover (#uaf634787-868d-5038-90cb-d4de4d9506c8) Title Page (#u5fab47ee-c377-5a87-b827-49531f4a18bb) Introduction Why I had IVF Polycystic ovaries stopped me ovulating My partner had no sperm I had premature ovarian failure I couldn’t give my son a sibling Cancer affected my fertility I’m a single mother by choice I’m in a same-sex couple Making the right choices How I found the right clinic Having IVF at 40+ I was only allowed one embryo transferred Ovarian hyperstimulation could have killed me I had reproductive immunology Why I used an egg donor My experience of surrogacy I got pregnant naturally after IVF Surviving IVF My twin IVF pregnancy IVF could have ended my relationship Therapy got me through IVF My friends and family got me through My experience of miscarriage Why I finally stopped IVF I moved on to a child-free life Why I adopted after IVF Afterword Further reading References Index Acknowledgments Copyright About the Publisher (#litres_trial_promo) Introduction • • • • • • • • • • • • • Idon’t know how long you’ve been trying for a baby, which fertility investigations or treatments you’ve had or what your chances are now of getting pregnant. You could just be thinking about having IVF, you might be a veteran IVF-er who’s had multiple cycles, or you may be about to start out on your first cycle. Wherever you are on your IVF journey, this book is for you. If I think back, I can still remember the feelings of inadequacy, shame and loneliness that I had when I couldn’t get pregnant. That was my motivation for writing this book, a collection of stories from 22 amazing women who are sharing them because, like me, they remember how it feels to be among the one in six couples who experience infertility. Each one of them volunteered to tell her story because she wanted to let you and others know that IVF can be hard, but that you can get through it. When I was first told I’d need IVF, almost six years ago, aged 35, I couldn’t talk to anyone about my fertility problems. Writing this book — admitting my infertility to everyone — and speaking to the women whose stories are told in these pages has been liberating for me. As one woman said to me, ‘IVF and infertility need to be brought out into the open. Nobody should be ashamed any more.’ But back then, I didn’t want anyone to feel sorry for me or pity me or gossip about me. I didn’t want friends to think they couldn’t tell me when they got pregnant easily. And I didn’t want my mum to be sad for me or worry about me. Adam, my husband, was a great support because, as a lifelong optimist, he always believed we’d have our family in the end. I loathed the hours spent waiting for fertility appointments in gloomy NHS corridors; and the appointments themselves were gruelling and made me feel very vulnerable. If you’ve ever had an HSG (an hysterosalpingogram, which examines your womb and Fallopian tubes using a dye that shows up when your abdomen is X-rayed), you’ll know why I walked out of the examination room when I saw the huge machine I was being asked to lie on, naked from the waist down. Most of the doctors were good at explaining things, and kind, but I still felt like crying at every appointment, just because I felt so sad and powerless. There were times when I couldn’t face yet another internal examination (one of the women in the book made me laugh when she said, ‘I automatically take off my knickers now as soon as I get into any doctor’s examination room’). Hormone tests and cycle monitoring showed my cycle was regular and I was ovulating, but the HSG showed my tubes might be blocked. Two years after I first went to the GP, I was booked in for a laparoscopy (a keyhole operation: a camera is put inside your abdomen via an incision under your tummy button). The surgeon discovered my tubes were blocked, and that I had adhesions, bands of tissue stuck to my internal organs, possibly due to a pelvic inflammatory disease that I’d had a few years earlier. Your tubes are so tiny and delicate, they can easily be damaged by infection and by adhesions. At this point, I was finding it hard to concentrate on anything but my fertility. I could cope pretty well with seeing pregnant friends (of course, this was the exact time lots of friends chose to procreate), but I was beginning to feel bitter towards innocent pregnant strangers in the street. Infertility brought out the nastiest part of me, and altered my perception of the world, so that having a baby became the only thing that counted. I spent hours obsessing over the next test, the next result, preparing for the next treatment, wondering what might make it work or even if I’d magically get pregnant naturally. The months between NHS appointments dragged on and on. Six months after the first laparoscopy I had another one, this time to clear away the adhesions and attempt to free up my tubes. It didn’t work. Another six months later, and I saw another consultant. He looked at my notes, pronounced me a perfect candidate for IVF and referred me on to the NHS IVF waiting list. I was nervous, as IVF sounded so medical and invasive, but frankly, after three years of blood tests, scans, internals, laparoscopies and waiting, I was relieved to be getting to that next stage. And what was cheering was that although IVF is now used for a whole spectrum of fertility problems — polycystic ovaries, failure to ovulate, endometriosis and malefactor infertility — it was actually invented to bypass malfunctioning tubes like mine. As the NHS waiting list for IVF was a year in our area at the time, and I was by then 35, we decided we’d better get on with having IVF privately. My mum kindly gave us some money towards it, and we scraped together the rest. I went to see fertility expert Zita West, who talked me through the pros and cons of the many London clinics. Another six months later, I was at my first appointment at the ARGC — the Assisted Reproduction & Gynaecology Centre in London. But just when I was ready to start my first IVF cycle, a doctor there scanned me and told me that my tubes were full of fluid due to having been blocked. He said that this could stop the IVF working, as the fluid can go into the uterus and prevent the embryo from implanting. Another gynaecologist agreed and said that my tubes and the adhesions around them were probably causing my awful period pains too. So I had another operation — this time to remove my tubes. It was a very final decison to make, and one I have occasionally regretted since. From that point on, IVF would be my only method of ever getting pregnant. That’s when I first found the Fertility Friends website, which has a forum for the ARGC, among other clinics. At first I just read other women’s conversations but one day, once I’d finally started IVF, I joined in, asking, ‘What does it mean that my left ovary is showing more follicles [the sacs that contain the eggs] than my right?’ And, a few days later, ‘Does anyone else feel twinges in their ovaries during stimulation? Or get spotting?’ I liked that lots of people replied, and everyone supported each other, cheered each other on and commiserated, really knowing what it felt like when things didn’t work out. My online fertility buddies were there for me during IVF, at all hours, day or night, ready with a quick boost or supportive comment. One woman who was always helpful on the forum was a GP called Alice, who is still a friend today (and whose story is told in Chapter 12). It became clear to me that some people who hadn’t been through infertility or IVF often didn’t ‘get it’. Toni (see Chapter 3) explains it like this: ‘People who haven’t experienced infertility don’t understand how it takes over your life, how sad it is that a vision you had of your life has been taken away from you.’ It was hard having to explain every step in the IVF process to friends and family, even when they were being loving and wanted to support me. I was lucky because at work, my boss and close workmates were kind too, asking me how things were going every day. The actual treatment was hardcore and physically demanding. At the ARGC, for the roughly two weeks that you’re injecting drugs to stimulate your ovaries to produce eggs, you have a blood test every day at 7 a.m., sometimes two, and scans every other day too. I still can’t drive near the blood clinic in Harley Street without feeling my stomach tighten. There was a lot of waiting around for scans and appointments at the clinic too. The waiting room was filled with an air of desperation mixed with camaraderie. People were in awe of Mr Taranissi, the head of the clinic, and talked about ‘Mr T.’ in reverential tones. I joked later that the chairs shouldn’t have been around the edges of the waiting room, but all in lines, as if we were praying to Mr T. Often, I’d chat to a neighbour about our treatments and I’d feel quite lucky, because while I was on my first cycle, others were on their third, even fifth. I had nine eggs collected in the end (I always think egg collection sounds more like a country pursuit than a surgical procedure). One of these went on to become my gorgeous, now four-year-old, son Patrick. I was nervous while pregnant, even though everything was textbook. And I’m still, to this day, a much more neurotic mother than I would ever have imagined I’d be; taking so long to have a baby changed me, in that way, for ever. When Patrick was two, we decided to try again with our two remaining frozen embryos. But I didn’t get pregnant. I had always said I’d be happy with one child, that I wouldn’t have another fresh IVF cycle, but found I couldn’t ignore my longing for a second baby, a sibling for Patrick. So we started a new cycle a year later. During a scan leading up to egg collection, I was upset as my eggs weren’t developing evenly on each ovary (I was pretty overwrought generally, at the time). The doctor said to me, ‘I have women in here who would be very grateful to be in your position.’ And I felt quite ashamed. This time, the result was a biochemical pregnancy. So while at first I did get a positive pregnancy test, for a week my blood levels of beta hCG (the hormone you produce when you’re pregnant) stayed the same, and then they started to fall — a sure sign that the pregnancy was over. That was torture. I was bowled over at how hard it hit me. I was already exhausted from the sheer emotional stress and hormone overload, and from juggling appointments with work; I just wanted to curl up under my duvet and hide. When Adam and I talked about doing IVF one more time, we didn’t know if we could go through with it, and we certainly couldn’t afford it. Mum asked me, ‘If you had enough money, would you have another treatment?’ And when she put it like that, I knew I would. ‘Never let a lack of money stop you from doing anything,’ she said. Her financial help and writing this book (ironically) paid for our next treatment, when I was 41. That time, we did get pregnant, but, sadly, I lost the pregnancy one day off 16 weeks (that story is in Chapter 20). After a miscarriage, and indeed if you can’t get pregnant, the world can seem full of pregnant women and babies, reminding you constantly of what you don’t have. Just after my miscarriage, an old friend called out of the blue to say that she was almost the same number of weeks pregnant as I’d been just a few days before; while back at work, a month later, three pregnant women got in the lift with me at the same time. I was a mess for a month and cried every day for the following two. Now I’ve accepted I’m the mother of a single child and I do feel extremely lucky for that. At the same time, I’m sad that my son is growing up without a brother or sister. I don’t want him to have the whole weight of my expectations, or the whole responsibility of us when we’re old. On the upside though, we’re a very portable family, Adam and I have lots of time for Patrick and he is a very happy and loved child. Our mothers and grandmothers didn’t have the medical options we have today to ‘cure’ infertility. Then again, for the most part, they did start trying much younger too, so there wasn’t, like there is now, an army of women in their late 30s and early 40s feeling let down by their biology. Medical science not only gives us hope, but also a huge range of options and decisions, with new breakthroughs being announced every month. Often, however, that also includes the chance to spend an awful lot of money with only a limited chance of success. What I learned from my own experience, more than anything, is that not getting pregnant is about making decisions. Lots of them. And often, these are involved and technical. For me, first, it was, should I push my GP to refer me for investigations after a year of trying or wait another six months? Then it was which IVF clinic is best — should I go to a clinic that has slightly better results, or one that provides more personal attention, or one that’s closer to home? Even as a health journalist, the amount of information that’s out there seemed overwhelming. Every decision was emotionally charged, as every choice could in theory make the difference between having the longed-for baby — and not. The final decision that my husband and I had to make was: is it time to stop treatment? Financially, it was just about impossible for us to continue, but emotionally, I reasoned, did I really want to put all of us — including Patrick — on to the IVF rollercoaster again when our chance of success was so low? Every woman in this book has had to make these kinds of decisions, and has made them in her own way. Their stories are not supposed to be a practical guide — there are plenty of other books out there fulfilling that need (you’ll find recommendations at the end of each chapter and in the Further reading section on page 311). Rather, they are intended to show you what others have done in the situation that you are in, what it felt like for them and how they made their decisions along the way. My day job is Health Editor of Red magazine, and the inspiration for the book came from Red’s Annual National Fertility Report. I wrote it in the period from a few months before my final IVF cycle to a few months after the miscarriage. All the women I interviewed taught me something that helped me in my final cycle, or that has stayed with me. For example, Amanda (see Chapter 1), showed me that you can choose to see IVF failure as a nightmare or you can view it as a learning experience for the next cycle. Oona (see Chapter 18), taught me to accept that, during fertility treatment, it’s normal for your emotions to be overwhelming. And lastly, Sinead (Chapter 9) helped me realise that when you don’t get what you want, you should still be thankful for what you do have. Hopefully, this book will show that for every desperate moment, for every heart-breaking test result and for every difficult decision you face, someone else has probably been there before you. And she’s here — and happy — to tell her story. Why I had IVF • • • • • • • • • • • • • ‘I was ovulating, but not getting pregnant. And I desperately wanted to know why. It was so frustrating.’ ‘All babies are miracles, but IVF babies are real miracles.’ ‘My mantra was: “As long as there’s one egg, I can get pregnant.”’ ‘After three IUIs in four months, I started pushing the doctors to recommend IVF because the success rates are so much better than IUI.’ ‘When I looked at him, he was the person whose biological children I wanted. I wanted a mini Nick running around, not to have to think about using somebody else’s sperm.’ Polycystic ovaries stopped me ovulating • • • • • • • • • • • • • The symptoms of PCOS all directly attack your femininity: facial hair, spots, weight gain. But the worst one of all is lack of periods and the resulting infertility,’ says Theresa Cheung, co-author of the book PCOS and Your Fertility, who herself underwent medical treatment to conceive her two children. ‘Getting pregnant felt like something I should have been able to do as a woman. It seemed so easy for other people. But I had to accept that it wasn’t going to happen for me naturally, that I needed medical help,’ she says. As the most common hormonal disorder for women, affecting up to 10 per cent, PCOS (polycystic ovary syndrome) is a major cause of fertility problems. As you may know, with PCOS it’s not that you’re not producing eggs, it’s that you don’t actually ovulate, which leaves your ovaries filled with follicles that have failed to launch — the so-called ‘cysts’. ‘The hormonal environment in the ovaries isn’t conducive to ovulation,’ explains Mr Tarek El-Toukhy, Consultant and ‘ Honorary Lecturer in Reproductive Medicine and Surgery at Guy’s and St Thomas’ Hospital NHS Foundation Trust. It’s now generally agreed that lifestyle is key for controlling PCOS symptoms, and healthy living can help to regulate your cycle. ‘Weight loss, if the patient is overweight, and exercise can both decrease the intensity of polycystic ovaries, and we see a lot of success just by doing this,’ says Mr El-Toukhy. Theresa agrees: ‘My symptoms — including a lack of periods — come back if I’m not taking care of myself by eating badly or not exercising enough.’ If you have PCOS, you’ll probably have had months, possibly years, of medical treatment by the time you reach an IVF clinic, usually starting with a drug treatment: one to induce ovulation, such as clomiphene (Clomid), and/or metformin, a drug used to treat diabetes. If this doesn’t work, the next line of attack is often an operation called ovarian drilling (this is exactly as it sounds). ‘We don’t know precisely how this operation works, but it could be related to the release of chemical substances within the tissue of the ovary, contributing to changes in the local hormonal environment and stimulating ovulation,’ says Mr El-Toukhy. Next comes IUI (intrauterine insemination — where sperm is put into the uterus around the time of ovulation), using the same ovary-stimulating drugs as IVF and, finally, IVF (although a lot of women choose to go straight from Clomid to IVF). • • • • • • • • • Amanda, 35, a public relations director from London, only found out she had PCOS when she came off the Pill. When ovulation-inducing drugs didn't work, she started IVF. I had no idea that I had polycystic ovaries until my weight ballooned when I stopped taking the Pill. I went from a size 10/12 to a size 16 in a matter of months. I’d been on the Pill since I was 17, when I first got together with Adam. By my late 20s, I wasn’t happy that I’d been taking it for so long and Adam and I were about to get married, so I came off it. Around six months after the wedding, I decided to see a doctor and get myself checked out because of the weight I’d gained and the fact that my periods had become so irregular too. That’s when I was diagnosed with PCOS. At the time, we weren’t trying to get pregnant, but we weren’t being too careful either. For contraception, we were simply avoiding sex on the days I assumed I was ovulating. Once I was diagnosed with PCOS, it turned out that my actual cycle was so irregular, I’d been avoiding the wrong days. So, in theory, I should have got pregnant and we had, in a way, been trying for eight months with no success. I started to use an ovulation kit, but it didn’t really work because I had such an erratic cycle. When I was monitored to see how often I was ovulating, there was no rhythm or reason to my cycle: sometimes I’d ovulate every two months, sometimes every four. Because I was ovulating so rarely, I realised we only really had around four chances a year to get pregnant. So when I was prescribed clomiphene (Clomid), a drug to make me ovulate, I was quite optimistic — you hear a lot of miracle stories about Clomid. The first month I took it, scans showed I didn’t ovulate. So the next month, the consultant doubled my dose. You do hear bad things about Clomid too, how it can give you mood swings, but luckily I wasn’t affected. This time I did respond and, amazingly, I got pregnant. A couple of weeks later, on my birthday, I suddenly felt very hormonal, and found myself crying for no reason. I tentatively put it down to being pregnant. Later that day, we went out for a family lunch. I felt some cramping then, during the meal, I started bleeding. When we’d finished eating, I told everyone we were going shopping but, in fact, Adam and I went to the hospital. There, the nurse asked me to do a urine sample for a pregnancy test, then told me I was no longer pregnant. I came home and cried all night, devastated. With my sister’s first baby due, my parents flew off to Hong Kong to visit her the next day, while I went back to my gynaecologist for a check-up. Just as I’d parked outside his surgery in Harley Street, my phone rang. It was my brother-in-law, calling from Hong Kong, to tell me I had a nephew. That hurt. I was genuinely happy for my sister and him but, at the same time, I felt sad and a real sense of loss for Adam and me. The gynaecologist said that if I wanted, I could carry on with Clomid in my next cycle without a break. With hindsight, I can see I should have taken a couple of months to get over what had happened, both physically and emotionally. I felt sad for a long time. What did help was telling myself that there was a reason the pregnancy hadn’t continued, that the baby most likely wasn’t chromosomally right. Ideally, you’re only supposed to take Clomid for six months, but I ended up on it for eight. I didn’t want to give up. I thought it was supposed to be a miracle drug, so I couldn’t understand why it wasn’t working for me. I was ovulating, but not getting pregnant. And I desperately wanted to know why. It was so frustrating. I was referred to another private consultant, who took me off Clomid and put me on a drug called metformin. This helps to control blood-sugar levels, which can be high in PCOS, and can regulate your cycle so you start ovulating. She explained that it would take a couple of months to work, and if metformin alone didn’t make me ovulate, I could combine it with Clomid. If I didn’t get pregnant, she explained, the next step would be IUI. As someone who’s extremely organised and used to being in control, those months of waiting for the metformin to work were hard for me. I kept thinking: friends are getting pregnant with their second babies and I’m struggling to fall pregnant with my first. And I was conscious that I’d be even older if and when I had a second child. The pregnancy I’d lost was still very much on my mind, and it was coming up to the due date. It felt like time was running away and there was nothing I could do about it. The one positive sign was that the metformin was helping me lose weight. Two cycles of metformin and Clomid together didn’t get me pregnant, so we started IUI. That ramped up the stress levels. We were spending nearly ?1000 a cycle and I was trying to fit in all the appointments with work, taking cabs to the clinic in lunch breaks because I was so busy. The actual procedure itself wasn’t fun either. The sperm transfer had to be done with a full bladder, and waiting for my turn was very uncomfortable. I know being stressed probably didn’t stop the IUI from working, but it certainly didn’t make it very pleasurable. Every time IUI didn’t work, we booked in for another round. Looking back, I can see we should have stopped after two or three times but we were advised to keep going. It was like groundhog day: every month, I’d find myself back at the clinic. Finally, Adam and I decided our fifth IUI would be our last, and it was time for IVF. I was referred to Guy’s and St Thomas’. We had all the standard tests and we were surprised to hear that Adam’s sperm count had dropped, never previously a problem. The embryologists recommended that once I’d had my eggs collected, they should be fertilised with ICSI (intracytoplasmic sperm injection — where a single sperm is injected into each egg), explaining it would give us the best chance of fertilisation. The staff, who were friendly and professional, put us at our ease, and made us both feel confident. The only thing that made me feel a bit sick was the thought of injecting myself with the ovary-stimulating drugs — I’m not good with needles or inflicting pain on myself. So Adam said he’d do them. We had to do our first injection at a friend’s wedding — in a Portaloo, of all places. Holding the little bag of needles and drugs, we were trying to stay calm when someone knocked on the door. The injections are dispensed by a type of pen, and we’d been told to hold it down for five seconds. But because we were so paranoid, we counted out loud to 10, just to be sure. Goodness knows what the person waiting for the loo must have thought! I dealt with IVF by going through the motions quite mechanically. Fortunately, the drugs didn’t affect my mood or emotions, so I was able to carry on with life as normally and unemotionally as possible. But, doing my last injection, I accidentally knocked the glass vial on to the ground and it smashed. So at 8 p.m., we had the panic of trying to get a replacement. Luckily, the clinic said they could fax a prescription to a pharmacy near us. But it took ages to find one that stocked the right drug, would accept a faxed prescription and was still open at what was by then 9.30 p.m. Looking back, it was farcical, but at the time, it felt like a disaster. When it came to the day of egg collection, we were pleased to get 12 eggs. We felt as if we’d got over the first big hurdle. Three days later, we had nine good embryos and the choice of putting one or two back. We automatically said two, as we wanted our chances to be as good as possible. Once the embryos were in, I felt that there was nothing more I could do. It was in the lap of the gods. A week after transfer, we took the Eurostar to a family wedding in Paris. When we arrived, I tried on my outfit — a black A-line skirt in a size 12 and a matching top — but I couldn’t do the zip up as my belly had expanded so much since I’d left London. I had to go shopping for new clothes and borrow a pair of my sister’s maternity tights (she was by then pregnant with her second child). I looked five months pregnant and a man in Galleries Lafayette actually gave me a chair because he thought I needed a break! At the wedding, I felt uncomfortable because I thought people would assume I was pregnant too. I knew the bloating was probably caused by mild OHSS (ovarian hyperstimulation syndrome), which I’d been warned about by the clinic. The main advice is to drink a lot of water, so I was going to the loo all the time. I could hardly move, I didn’t dance, and I felt huge. Towards the end of the evening, my sides started hurting too and I began to feel really uncomfortable and knackered. When we got back from Paris, I called the clinic, and told them about my bloating. They asked me to come in, in case they needed to put in a drain to take out the excess fluid that builds up with OHSS. The first thing the nurse asked was if I’d done my pregnancy test. I said no, because I thought I wasn’t due to take it for another two days. And she said, ‘No, you were supposed to take it yesterday!’ How the hell had I got my test date wrong? Probably because I’d been so determined to go on with normal life, and not think about IVF, that I’d pushed it to the back of my mind. In shock and on autopilot, I went to the toilet and peed on the test stick. I didn’t even look at it. In my mind, I wanted to give the test to the nurse, go home and for her to call me with the result. As I passed the test to her, a faint line on it caught my eye. I said, ‘Oh, I guess that means the treatment didn’t work; there’s only a faint line.’ She said, ‘Actually, that means you are pregnant.’ I couldn’t believe it. I was elated, but made myself stay calm as I knew it was early days for the pregnancy. I went through the rest of the examination in a daze. Luckily, I didn’t need any treatment for the OHSS, and was just told to drink more water. I called Adam, told him that the OHSS wasn’t serious and rambled on about my appointment before saying casually, ‘Oh, by the way, I’m pregnant’. He was ecstatic, of course. We decided not to tell anyone for a while, because of losing the previous pregnancy and the fact that this one was still so new. Two weeks later, I started bleeding at work. It’s just not fair, I thought. It’s happening again. Adam called NHS Direct, who told us to go to A & E. After waiting for hours, we finally persuaded the doctor to do a scan. Incredibly, we saw one heartbeat, and that was a huge relief. There was another sac, but it looked like a dark circle with nothing in it. The doctor said, ‘There’s one heartbeat, but it looks as if the other embryo didn’t make it.’ That was the first time that the idea of twins had crossed either of our minds. I actually felt a loss for the second twin, thinking that it had grown inside me for a few weeks. But, as Adam said, we should be very grateful for our one healthy heartbeat. My mum, who has a medical background, said it was probably a good thing that we’d ended up with one, as twins can be such a difficult pregnancy, and often one or both of the babies is sickly or they’re premature. Everyone put a positive spin on the situation but, for me, it was still bittersweet. Then, at our first official scan at the IVF clinic, at eight weeks, just as I was telling the doctor we’d only seen one heartbeat, she said, ‘Well, now you’ve got two’. I practically fell off the bed. She explained that the heartbeat comes between six and eight weeks of pregnancy, and the first scan was probably too early. We were shocked, but also delighted. Even though I was only a couple of months pregnant, my stomach was very big, so I told people at work that I had something wrong with my digestion (I’d had digestive problems in the past). It wasn’t until after the 12-week scan, when we found out that both babies were healthy, that we finally felt confident enough to share our news. But, at 15 weeks, I suddenly started bleeding again. I kept thinking: I don’t want to lose one, they come as a pair, but, despite feeling well, I could only assume we’d lost one or both babies, as there was so much blood. At A & E, after several examinations by different doctors, none of whom could find anything wrong with the pregnancy, it was discovered that I had a burst polyp — a little growth on my cervix — and that this was what had bled. The doctor was very kind and understanding and I’ll always remember him saying to me: ‘All babies are miracles, but IVF babies are real miracles.’ For the rest of the pregnancy, I had scans every two or three weeks, which made me feel safe. Nathan and Dylan were born healthy, by C-section, exactly a month early (they did go into special care for two weeks because they couldn’t yet feed). After they were born, all thoughts of Clomid, IUI and IVF disappeared. It’s no longer relevant to me how the boys were conceived. All that matters is that we have two healthy, lovely children. Q: WERE YOU OFFERED ANY OTHER TREATMENTS FOR PCOS? After we decided to stop having IUI, I did see a consultant who recommended a procedure called ovarian drilling, where a surgeon makes holes in your ovaries in order to restart your cycle. I did consider it, even went on the waiting list, but it seemed very extreme. I thought of it as a last resort, if IVF didn’t work. Q: HOW ARE YOUR PCOS SYMPTOMS NOW? The boys were born in January and I was thin within a couple of months, but by June of that year, I had put on loads of weight again. I could also see that I was a little more hairy too. Even though metformin had suited me so well, and the doctors were happy for me to go back on it, I didn’t want to take it. I didn’t like the idea of being on medication for ever. And I didn’t think, with the babies, I’d remember to take it three times a day, in any case. I kept thinking: maybe the symptoms will calm down or I’ll eat less. When the twins were three, I decided to go back on metformin. It has made a difference – I’m definitely less hungry and I’m down to a size 10/12 again. Q: DID YOU TELL PEOPLE WHILE YOU WERE HAVING IVF? I was quite happy to tell some people about our fertility treatment, but not everyone. I worked up until twenty-nine weeks; one of my ? nal tasks was organising a celebrity event. Everyone there kept saying to me, ‘Oh my God, you’re massive,’ assuming I was about to drop there and then. So I had to explain it was a twin pregnancy, and the inevitable next question was always, ‘Oh, have you got twins in the family?’ and, ‘Are they identical?’ When people ask if there are twins in the family, I think what they’re really saying is, ‘Was it IVF?’ But, to be honest, I’m not embarrassed by it. I usually say simply that it was fertility treatment – most people don’t ask for details. I’m also asked, ‘What are you going to tell the children about how they were conceived?’ But I don’t think they’re going to care about the actual mechanism of conception, especially these days. I was making dinner the other day, stirring something, and Dylan said, ‘Is that how you made us?’ He knew that he and Nathan had been in my stomach, and assumed they must have got there the same way as food! If we’d used donor sperm or eggs, I think it would be different, as then it’s a question of genetics. Q: WHAT WILL YOU DO WITH YOUR FROZEN EMBRYOS? We’ve got seven embryos frozen from our treatment. Recently, I got a letter saying that they’re about to reach their ? ve-year deadline, and we have to decide what to do with them. We’re not going to use them ourselves, as we don’t want any more children. We’re still having a debate about what to do with them. If it was just my eggs, I could donate them to someone who needs them. But I’m not comfortable doing that with embryos, as they are, theoretically, full siblings to Nathan and Dylan. If I did, I might start thinking every child I see on the street is genetically ours. I would like to give them to medical research, as for me it’s important to give back, but Adam isn’t keen as he doesn’t want them to be prodded and experimented on. He’d rather let them be destroyed. I think I’ll probably win the argument in the end, but it might take a while. Q: WHAT’S YOUR BEST ADVICE FOR ANYONE DOING IVF? You need to keep calm. I’m sure that part of the reason why IVF worked for us is that we’re quite calm people. And I made sure I stayed that way. My belief is, only worry about things when you absolutely need to. Also, try to be positive and don’t think about it not working. Try to go about your normal daily life and don’t let everything be about IVF. Just before I had IVF, I met a woman who’d had multiple cycles of IVF and had made some extreme life changes she thought would help it work. She was on a strict organic diet, not using foil or plastic on her food and avoiding microwaved food. But I knew that wouldn’t have suited me. I believed that the more changes I made away from my normal life, the more I would have been setting myself up for disappointment had IVF failed. The hard thing, when you’re having fertility problems, is when your friends are falling pregnant around you – especially, I found, when they are having their second. But you have to be positive and think: their second won’t take away my first. Q: WHO WAS YOUR SUPPORT SYSTEM? I had my best friends, my parents and, of course, my husband Adam, although, ironically, I probably spoke to him about it less, as I didn’t want it to be all-consuming for us. After a while, Adam’s attitude was sometimes, ‘Do we really need to talk about this again?’ He always believed it would happen for us. And, as a man, he wasn’t as conscious of my biological clock, so he didn’t mind if it happened straight away or in a year. • • • • • • • • • Difficult though it is to live with the symptoms of PCOS, the good news is that the majority of women who have it and want to get pregnant, do so. But that doesn’t mean it isn’t a hard slog to get to that point. For excess weight associated with PCOS, some women swear by the GI diet: ‘Many nutritionists, dietitians, and women with PCOS believe the lower sugar and lower refined carbohydrates in the GI diet really work, by reducing insulin resistance and keeping hunger pangs at bay,’ explains Colette Harris, co-author of PCOS and Your Fertility (Hay House) and The Ultimate PCOS Handbook (Thorsons). ‘The basis of the diet is more protein, more fibre and less sugar,’ she says. And while there’s no consensus on how often or how hard you should exercise, she recommends some exercise every day, even if it’s just gardening or brisk walking. If you are keen to explore complementary treatment for PCOS, a Swedish study from 2010, (#litres_trial_promo) where women had 16 weeks of electroacupuncture (where the needles are linked up to a minimal electric current) had more periods as a result. Fertility acupuncturist Emma Cannon (emmacannon. co.uk) says that most of her clients find their cycles return after one to two months of acupuncture. And there’s more good news: a study published in 2010 from the Shahid Beheshti University in Iran (#litres_trial_promo) compared the AMH blood levels (anti-M?llerian hormone — a marker of fertility) of women with PCOS and those without, and found that AMH declined to menopausal levels on average two years later in women with PCOS, which means they have a better chance of conceiving at a slightly older age (#litres_trial_promo). Finally, Verity, the PCOS charity, runs conferences with expert speakers (verity-pcos.org.uk); you do need to be a member, but they can keep you up to speed on all the latest research. You can download previous conference speeches at the website of PCOS-UK, the education arm of Verity (pcos-uk.org.uk). My partner had no sperm • • • • • • • • • • • • • When a man finds out that he’s subfertile, it can be a huge knock. Thinking he might not be a father can change how he feels about himself,’ says fertility coach, Anya Sizer. A low or even a zero sperm count doesn’t mean a man can’t be a father, though. ‘There is a range of sperm counts in men, some have lots, some very few,’ says Dr Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield. ‘And the definition of healthy sperm count recently went down from 20 million per millilitre to 15 million. At that level, a man should be able to become a father within a year. But you can be “abnormal” by that definition and manage it in, for example, two years.’ Male fertility treatment has seen the biggest technological advances in the past 10 years. ‘We don’t have any magic pills to stimulate men to produce more sperm. What we do have are ways of extracting sperm or doing the best we can with the sperm that we can get,’ says Dr Pacey. By using‘ intracytoplasmic sperm injection, or ICSI, embryologists can now fertilise an egg with a single sperm. Even if tests show zero sperm in a man’s ejaculate, there are several surgical techniques that can extract sperm, when previously a man would have had to use a donor to have a family. ‘Finding nothing in ejaculate is unfortunate,’ says Dr Pacey, ‘but it doesn’t necessarily mean that a man’s testicles aren’t producing any sperm, just that they’re not making it out in the ejaculate or they haven’t been seen in the lab. When we look at ejaculate, usually several millilitres of fluid, it’s impossible to look in every single bit of it. Theoretically, there could still be several thousand sperm in there, when we see nothing.’ The major factors that affect sperm count and/or quality are genetics (including having undescended testicles at birth), trauma, chemotherapy and vasectomy. The surgery of choice if there’s a blockage, for example after vasectomy, is aspiration via a needle, usually taken out of the tube which carries sperm from the testes to the penis (PESA — percutaneous epididymal sperm aspiration), but sometimes from the testicle itself (TESA — testicular sperm aspiration). These are procedures that are performed every day. My dad had a vasectomy over 20 years ago, which meant he couldn’t have it reversed when he wanted to have a child in his 60s. So he had PESA to help conceive his now toddler daughter: ‘I had a full anaesthetic but I was only out for thirty minutes. There was no pain or bruising afterwards; the only slightly embarrassing part was that the nurse who helped with the op was so chatty!’ ‘After a vasectomy, there’s usually a hundred per cent success rate at getting sperm surgically. These men were obviously fertile in the first place,’ says Dr Pacey. But, he explains, ‘With a man whose fertility has been affected by chemotherapy, the success rate is perhaps about forty per cent.’ These men, or those who had undescended testicles at birth, may need to have an operation called TESE (testicular sperm extraction), where tissue is removed from the testicles, then dissected to find any sperm. There are a lot of other factors affecting sperm quality and quantity too. These include sexually transmitted infections (‘In my lab’s last study, thirteen per cent of men referred by their GP for fertility tests had chlamydia and didn’t know it,’ says Dr Pacey), flu or any illness with a temperature, prescription medicines including some SSRI antidepressants and anabolic steroids, sitting down a lot (for example, men who drive a car for more than two hours a day), smoking, over-drinking, working with various chemicals (glycol ethers, in paint, glues, dry cleaning fluids) and long exposure to lead in petrol or exhaust fumes. Of course, even once you have the sperm, pregnancy isn’t guaranteed, as Ella, whose story is below, found out, because to do ICSI, you’re relying on the success of IVF. • • • • • • • • • Ella, 37, a marketing manager from Bristol, and her husband Nick were told that he had a zero sperm count. Nick was at the airport with a group of his friends, about to go away on a boys’ weekend to Berlin, when he got the call to say he wasn’t producing any sperm. He’d had the test done at our local hospital, and when the nurse called him to give him the results, he was sitting in the bar, drinking with his mates. To be in that testosterone-fuelled environment, then be told you have no sperm count and, therefore, no chance of fathering a baby seemed the ultimate irony. He had half expected it, but it was still a shock. His very worst fears had turned out to be true. Nick had been concerned about his fertility ever since his early teens. That’s when he’d found out that when he was born, his testes were still inside his body — ‘undescended’. He did have an operation to correct it, but not until he was six years old. Nowadays, doctors think it’s best to do that operation as early as possible, as it’s thought that high temperatures inside the body may affect sperm production later in life. The actual operation may do so too. Nick told me about the operation within a couple of weeks of us starting to get serious, so I knew it was important to him. Without him telling me, I’d never have known he’d had it; as an adult, the only sign was a tiny scar on each side of his testes. Once we’d got the news he was producing zero sperm, my first thought was to find a solution. We asked to be referred to a urologist (a specialist who deals with male parts), but he told us the same thing as our GP: that our options were now sperm donation or adoption. He also did some blood tests, which confirmed that Nick wasn’t producing any sperm, despite the appearance that things were working normally. It was our first encounter with a specialist, and I was shocked at how, for him, it was an everyday job. Considering he was telling us our future, he seemed quite offhand — he even answered the phone in the middle of our consultation and chatted for 10 minutes. He was so used to dealing with fertility issues, it wasn’t a big deal to him, but it was our life. Because Nick had worried about not being fertile for so long, then had had his worst nightmare confirmed, it was pretty hard to find the right way to help him. It felt as if I was treading on eggshells. The hardest part was that it had happened to him when he was little, and so he had had no control over it. It wasn’t as if he’d taken steroids or even that he’d had cancer or an accident. I know he was thinking: why me? I was devastated too. We’d just got married but, potentially, I was facing not being able to have his child. That was a really sad prospect. Part of getting married was wanting to create a family together. When I looked at him, he was the person whose biological children I wanted. I wanted a mini Nick running around, not to have to think about using somebody else’s sperm. So while I was trying to be strong for him, I was trying to deal with my own emotions too. But I’m a very persistent person, so we went back for a second appointment to ask if there were any other tests we could do. The specialist said there was one option — an operation called TESE, where incisions are made in the testes, at the top and bottom, some of the sperm-producing tissue is removed, then whatever sperm is found in it is retrieved and frozen. I’d have to have IVF to produce eggs, then Nick’s sperm would be thawed and injected into my eggs, using the ICSI technique. The specialist told us that some clinics and hospitals are more experienced and better than others at TESE, so I asked him the very best place to have the operation. He mentioned a clinic in Brussels, where ICSI was actually pioneered. Nick and I discussed whether or not to go ahead and decided that we didn’t have much to lose. If the operation didn’t work, at least we would have done everything we could to have our own biological child. We didn’t feel we could move on to thinking about donor sperm or adoption until we knew that. So, a few weeks later, we booked our flights to Brussels. The clinic there was quite a culture shock after what we’d seen of British hospitals. It was modern in its design and high-tech. The staff were very welcoming and professional. There was no language problem because we were assigned an English-speaking counsellor, and she arranged and attended all our appointments and was our point of contact throughout the whole process. When we met with our consultant, he made us feel comfortable too. He assured us that a lot of couples were in our situation, and said that Nick was a suitable candidate for the operation. He explained that there would be an embryologist in the operating theatre with a microscope, and as soon as the tissue was removed, he or she would check the sample for sperm immediately, and freeze whatever was found. He also said that if they didn’t find any sperm during the operation, the clinic would help us to move on to other options. That night, we went out for dinner in Brussels. We’d decided to spend some of the money we’d saved for treatment on dinner, a nice hotel and some sightseeing. It was April, and it was warm, so we ate outside in Brussels’ famous and very beautiful historic square, Grand-Place. Being away from home together felt very special. Some of the usual stresses disappeared and it gave us time to talk — I think Nick was the most open he’s ever been. We were put on the waiting list at the Brussels clinic, but amazingly the counsellor called the next day to say they’d had a cancellation for two weeks later. So we booked in. Once we got home, however, we began to get nervous. It’s obviously not great for a guy to have his bits sliced up, and we had also been warned there was a small risk his testosterone levels could drop after the operation, so he’d have to be on hormone replacement therapy, and the drop would put him at risk of osteoporosis too. The more I read up, the more I worried. I lost my dad when I was fifteen and since then I’ve had a phobia of hospitals. I got completely carried away, thinking: Nick and I have only been married six months; will I lose him too? That’s where the counsellor came into her own. She told us on the phone that the clinic did the same operation every single day. And she explained that some men do have a tiny drop in hormones after surgery, but that it usually only lasts for around a year. I was vocal about my fears to Nick, but he stayed level-headed. He said the operation didn’t scare him, and that it was very important for him to know if he could father a child or not. Two weeks later, we were back in Brussels. The night before the operation, I had to help Nick remove the hair from his bits using cream. I know a lot of men do shave or wax now, but I’m not sure many of them use Immac! It was a really girly scented one too, and that made it even funnier. Nick made me swear never to tell his mates. On the morning of the operation, I was so nervous that I hurried us too much, and we arrived at the hospital an hour early, at 6.30 a.m. I didn’t want to be teary in front of Nick, but I was feeling very emotional. I was terrified he wouldn’t come round from the operation. He, of course, was absolutely fine, being his usual self and joking around when they gave him some unattractive paper pants to put on. We waited in a room with a Dutch couple who were having the same operation. Luckily, we were going first. Nick was put on the bed to go to theatre at 8 a.m. He’s quite a big muscular guy, and when he lay down, the trolley started to collapse. I couldn’t help but laugh. As soon as they took Nick off to theatre, I started crying. I was so worried. I kept thinking that making a baby is supposed to be a special experience, not a medical one. I felt lonely, knowing he was under anaesthetic, and that the outcome would decide if we could have children or not. I thought he was so brave to have the operation. A tiny bit of me was hopeful, but I kept talking myself out of it because I didn’t want to be let down if it didn’t work. It only took a couple of hours for Nick to come round after surgery, but it felt like for ever. When he was wheeled into the recovery room, he was still high, so he was joking around a bit, telling me how pretty the nurses were. I was pleased he was positive, but he was also quite groggy and it was unnerving to see him not being himself. A nurse came in and said, ‘I hear it’s good news.’ I said, ‘Oh no, I don’t think so.’ I was so convinced it wouldn’t be. But the nurse went on, ‘No, they looked at the tissue in theatre and they found sperm.’ Nick went to sleep at that point, and I was sure she had confused our results with the Dutch couple’s. But an hour or so later, our specialist came in and gave us both a massive hug. He said they’d found plenty of sperm; on one side, they hadn’t found anything (the original operation to bring down the testicles had, apparently, been botched), but on the other, they’d managed to extract twelve straws. Each straw is a vial the size of a match, and you only need one to have ICSI. We still had quite a lot to do before we could have a baby, but we were on our way. While we were hugging and laughing with relief, the Dutch couple had found out they had a negative result. We could hear the woman crying through the curtains around her partner’s bed, and we really felt for them. It so easily could have been us. As we left the clinic later that afternoon, Nick wasn’t in any pain, but he was walking like John Wayne, as if he’d just got off a horse, which made us laugh. Amazingly, the swelling went down fast after the first day, and after a week or so, the stitches had dissolved; after two weeks the wounds were completely healed. The surgeon had gone in through the same incisions that had been made when Nick was a child, so there were no new scars. We were so impressed and grateful; I even called the surgeon to say what a great job he’d done. I wanted to crack on with my part of the treatment to keep the momentum going. Scans and blood tests at the clinic showed that I was ovulating and producing lots of eggs, so I could start the injections to stimulate my ovaries a few weeks later. The counsellor showed me how to do the injections on an orange, and I soon got over my needle phobia. It was quite complicated to be treated abroad: I was being monitored at a clinic near home, who would fax my results to work, then I’d fax them on to Brussels. Then Brussels would call me to say if I should change my drug dosage. Once the follicles were a certain size, I did the injection to make me ovulate, and we got on the Eurostar the next morning. It was scary, knowing I was about to release all my eggs, and I spent the whole journey hoping we’d get to Brussels on time. I was nervous about the egg-collection procedure, but it helped that Nick had already had an operation. He was very supportive, though I could tell he hated that I was having to go through so much. In the morning — roughly 36 hours after my final injection — I was wheeled into the same operating theatre where Nick had had his surgery a few weeks before. Egg collection is done under local anaesthetic at that clinic, so I had an injection in my bottom. But I don’t think it worked, as once they started doing the actual egg retrieval, via a needle through my vagina, I felt everything. I’m normally quite good with pain, but I was in agony. The only way I can describe it is like someone pushing a red-hot needle into your lower tummy, then feeling something being sucked out. Because I’d never had it done before, I assumed this was how it was meant to be, so when the nurse asked me if I was ok, I kept saying I was fine. For the first four or five eggs, I thought I could cope, but then the pain got too much and the anaesthetist put something in my drip, which helped a bit. In all, they collected 18 eggs, and the whole process took half an hour. When I was wheeled into recovery, I told Nick how horrific it had been. I couldn’t move as I was in so much pain. But we had good news almost straight away: 16 out of the 18 eggs were viable. Then we were on to the next worry: would Nick’s sperm survive defrosting? It did, but the clinic don’t give out any more information about fertilisation, so we had to endure three days without news of the embryos. We were staying in a nice hotel which helped take our minds off what was happening at the clinic, but it was a nerve-wracking time. On day three, we were having breakfast, when the counsellor called to say they’d like to do the transfer in two hours. We were very excited and phoned our families to say that it was finally going ahead. I felt much happier about going into the theatre with Nick holding my hand this time. But once we got to the clinic, there was bad news. Of the 18 eggs, only three had actually fertilised and only one was still alive at day three. We told each other that we only needed one, that it could still work, but the quality of the embryo wasn’t that great, and we were disappointed. All that effort and stress, all those injections, and we were left with a single, solitary hope. After transfer, I rested in bed at the hotel for three days, as I felt that would give it the best chance of working, then we took the Eurostar home. The two-week wait was hard; with every tweak and sensation, I couldn’t help questioning if I was pregnant or not. Then, the day before the end of the two-week wait, I was about to go out to my sister’s birthday party, when I got my period. Even when you’re trying to get pregnant naturally and you get your period, it feels as if you’re losing something. But this time, that feeling was much more brutal. Somewhere, I knew there was a little embryo that hadn’t taken. We’d had mainly good news until this point, so it took us a while to realise that, this time, it really was bad news. I wanted to try again straight away, but when I rang the clinic, they advised us to wait three months, to give my body time to settle down. They were really encouraging; they said we should think of our first go as a trial, and that we had loads of sperm left. I think taking that break was sensible, even though it felt as if we were back to square one. That was our lowest point. I needed to keep talking about it, but Nick was happy to talk about it just once or twice, then move on. We hadn’t lived a normal life for ages, so we tried to spend time together, and see friends and family. There were a lot of weddings that summer. It was hard because we hadn’t told anyone we were having treatment, and people kept asking us when we were starting a family. At home afterwards, I’d always end up in tears. The second treatment cycle was pretty much the same as the first: 16 eggs but, in the end, only one embryo was viable. It was easier, as I knew about the injections and all the procedures. In the end, we were unlucky again. I found out I wasn’t pregnant when I went to the loo at a friend’s wedding and I’d got my period. I went out and had a glass of champagne, because I could. I felt awful. The next morning, lying in bed, I was idly Googling IVF, and I put in ‘best results’. The ARGC in London came up. Nick had wanted to wait for few months for our next treatment, but I was impatient. I managed to get an appointment for a few weeks later, and took the train to London. I was expecting a grand Harley Street set-up, but the ARGC is pretty well worn. The doctor we saw was very helpful and easy to talk to. Pricewise, I knew it was more expensive than some other UK clinics, as there are a lot of extras (for example, daily blood tests), but then travelling to Brussels hadn’t been cheap either. The doctor recommended I have a hysteroscopy — an operation where the doctors look inside your womb using a camera inserted via your vagina — which, he said, may help increase the chances of success. I had to be monitored for a month too, so we couldn’t start the actual treatment for a couple of months. In the meantime, I went part-time at work, as working full-time and doing IVF had become too stressful. I borrowed a flat in London, as I had to have daily blood tests and go into the clinic for scans and drugs too. The nurses and staff were very kind and, through talking to the other women I met there, I learned that everyone seemed to be on different drugs and dosages, so I was confident that I was getting treatment personalised to me. The day of egg collection and fertilisation was nail-biting. We had arranged for Nick’s sperm to come over by courier from Brussels, but the flight was delayed. Nick had to be in the clinic early, ready to have another operation, just in case the sperm didn’t arrive or hadn’t survived. To my huge relief, egg collection at the ARGC is done under general anaesthetic, so I didn’t feel a thing. When I woke up, the nurses were laughing. I asked if everything was ok, and they said, ‘Yes — we’re now calling you the eighty-egg girl!’ Apparently, in my half-awake state, I’d asked a nurse how many eggs they’d collected, and, though she’d said 18, I’d thought she said 80, and repeated it. It took the embryologists an hour to find viable sperm in the straws. In the end, they found enough and did ICSI on my eggs. Out of the 18 eggs, this time 16 fertilised. By day three, we still had eight good embryos, so they said we should hold off until day five, when the embryos would reach blastocyst stage (an advanced stage of development); this would allow them to choose those that had the best chance of implantation. On day five, they called us and said, ‘Actually, we still can’t choose between them, as they’re all looking good, so we’re going to wait until day six.’ We had two good-quality blastocysts to put in that day. Sadly, the others had started to die away, so we had none to freeze. I was really churned up. It felt like we’d reached the end of a big journey and I couldn’t work out what we’d do next if I didn’t get pregnant. Before embryo transfer, I asked if I could see the embryos, but the doctor, Mr Taranissi, said that too much movement can be traumatic for them, and that he preferred to put them straight in. After transfer, he left us alone for half an hour, saying, ‘This is your moment to be together.’ I felt so full of emotion. I said to Nick that I could feel it working. He told me not to be silly, that it was far too early, but I really did feel positive. When it was time to stand up, I was scared. But the embryologist reassured me with a really clever image. He described the womb lining as being like the bread of a jam sandwich, so the embryos couldn’t fall out. I still spent the journey back home the next day with my feet up on the dashboard, though. I must have looked like Lady Muck, the back seat crammed with bags from my month spent shopping in London, and the seat pushed back as far as it would go. The next 10 days of waiting were hard. But I was disciplined, and didn’t do a home pregnancy test. I took the blood test at the clinic at 7 a.m., then Nick and I went for breakfast at a lovely caf? nearby called Patisserie Valerie. We both ordered scrambled eggs and bacon, but I was too nervous to eat. The call came and it was positive. I couldn’t process the enormity of it. If we hadn’t pushed to have the operation, if we hadn’t kept going with treatment, we never would have had this incredible news. A few weeks later, we discovered that we were having twins, and Mia and Milly were born by Caesarean section at 38 weeks. It was a surprise, as we had thought we were having at least one boy, but it was an incredibly good one. We both feel so privileged to be parents, when we’d been so close to it never happening. Q: WHAT’S YOUR ADVICE TO ANYONE DIAGNOSED WITH A LOW OR ZERO SPERM COUNT? See a specialist and find out all the possible options. We went to our GP to discuss the first set of sperm-test results. He’s a great GP, but not a fertility specialist. He just said, ‘You must be devastated,’ and that there was no way Nick could father his own children. I’m really pushy until I’m completely convinced; I thought: that can’t be it – there must be some new technology that can help us. It was only when I asked to be referred to a urologist that we got a more detailed picture. Q: WHAT DID YOU TELL FRIENDS ABOUT WHY YOU HAD TO HAVE IVF? At first, we didn’t tell anyone anything. Once we decided to tell a few close friends we were having treatment, after our first failure, everything became a lot easier. Before, I’d felt as if I was lying all the time. Everyone in our group was so supportive and it was amazing how many people knew people who’d been through it. We didn’t tell them why we had to have IVF though – people naturally assumed the problem was on my side, and we let them. Q: HOW DO YOU THINK A ZERO SPERM COUNT DIAGNOSIS AFFECTED YOUR HUSBAND? I suppose all men who want children worry, to some extent, about their fertility and whether they’re going to be able to father a baby. After Nick’s diagnosis, but before anyone else knew we were trying, I remember a guy at a wedding telling us his wife was pregnant, joking he had ‘ace swimmers’. Even though it was in jest, it hurt. Nick is very down to earth and practical, so he doesn’t talk very much about his emotions, but I know he found it hard to take. His reaction was to shut down and not want to talk. I didn’t push him: I read some good advice that said men can talk about fertility for a maximum of three days, and then they want to move on. I’m lucky because, when I needed to talk, I could go to my mum, sister and friends. Q: WHAT WOULD YOU HAVE DONE IF YOU HADN’T GOT PREGNANT? The idea of sperm donation seemed very alien to me, whereas adoption seemed more natural. At the time, I also thought it would be easier, though I’ve since found out it can take a lot longer. Q: WHAT’S YOUR BEST ADVICE FOR ANYONE HAVING IVF? Make sure you rest properly after embryo transfer. Your body has been through a lot, and so have you. And you want to give yourself the best chance. For the first week after the third transfer, I went to stay with my mum. Not that Nick didn’t look after me, but I knew that if I was at home, I’d end up doing housework. Mum made me lie down and did everything for me. The other piece of advice is, don’t test early, as you can get the wrong result. I met a girl at the clinic who’d done a home test that showed up positive, but her blood test showed very low levels of pregnancy hormones, and it turned out to be a negative in the end. • • • • • • • • • Looking for people to speak to for the book, I tried to find a man to interview whose child had been conceived using donor sperm and whose partner had had IVF. Even though there are thousands of children conceived using donor sperm every year, I couldn’t find one. Perhaps ICSI has meant a drop in the numbers of male—female couples using donor sperm. Or perhaps men just don’t want to talk. It’s interesting that of the couples I spoke to whose infertility was partly or wholly ‘male factor’, all of them allowed friends and family to think that the issue was the woman’s. Fertility coach, Anya Sizer, says she always recommends the website mensfe.net, which is dedicated to male fertility issues, as a good source of information and support. It appears (as a generalisation) that men prefer not to share in the same way that women do on fertility websites; there are a lot fewer posts on the forums, but each one has been viewed hundreds, sometimes thousands, of times. Mensfe.net is an excellent website and includes personal stories, as well as information on vasectomy reversal, sperm donation and nutrition, plus questions answered by doctors and a section on the emotional effects of fertility problems. As regards nutrition, the latest research shows that it may be worth men whose partners are having fertility treatment taking antioxidant supplements, such as vitamin E, L-carnitine, zinc and magnesium, although it’s not proven which particular supplements are most effective. That’s the conclusion of a 2011 Cochrane Review of 34 randomised controlled trials involving 2876 couples. (#litres_trial_promo) The Donor Conception Network (donor-conceptionnetwork.org) has a section aimed at men that includes personal stories. If you’ve been told that your best option is donor insemination, it’s recommended you have counselling first. And be clear about your legal situation: in law, if you are married, you (the ‘intended’ father) are automatically the legal father if your child has been conceived by donated sperm, but that’s not always the case if you’re unmarried. (See www.nataliegambleassociates.com for more information.) Infertility Network UK have a very useful factsheet on exactly how ICSI works, one on male infertility generally and one on the emotional side of male infertility (www.infertilitynetworkuk.com). For a full-length account of IVF from a male point of view, read Test Tubes and Testosterone: A Man’s Journey Into Infertility and IVF by Michael Saunders (Nell James Publishers). ‘The idea behind my story was just to get men talking about fertility. I imagine it will be bought by women and hopefully read by men,’ says Saunders. I had premature ovarian failure • • • • • • • • • • • • • What happens when you start trying for a baby, then find out that you are having an early menopause and that your hope of any fertility treatment working has just plummeted? The accepted statistic is that one in 100 women has her menopause by the age of 40 (usually called premature ovarian failure, or POF). However, a new study from Imperial College, London, puts the number much higher, closer to one in 14, including those who have had surgery or treatment for cancer. (#litres_trial_promo) POF can be devastating, even for women who’ve finished their families. A friend I interviewed, who had her menopause at 37, said, ‘Not only was I having hot flushes, feeling angry and putting on weight, but I was doing it ten or fifteen years before my friends, so there was no one to talk to about it. It didn’t seem fair.’ Although, when you think of the menopause, you probably think of the typical symptoms my friend described, what it actually means for a woman is that she has gone through her store of eggs. ‘At birth, your lifetime supply of eggs — your ovarian reserve — is already determined,’ says Professor Bill Ledger, Professor of Obstetrics and Gynaecology at the University of Sheffield. You release one egg every 90 seconds — one of which matures each month — and when your store is gone, it’s gone. ‘Ovarian reserve can be reduced by ovarian cysts, surgery on an ovary, chemotherapy and radiotherapy. You also speed up the rate it reduces by drinking too much and smoking,’ says Professor Ledger. But, for half of all women who have POF, no reason is usually found. ‘My guess is that women who have an early menopause probably have a smaller lifetime supply of eggs to start with,’ he says. An early menopause often runs in families — so if it’s happened to your mother and grandmother, it’s more likely to happen to you too. Early menopause wasn’t such an issue for our grannies, of course, who tended to have their children younger, but the average age of new motherhood in the UK is now almost 30. ‘Mum had her babies in her 20s,’ says Toni, whose story is below, ‘so even if she had had an early meno-pause, it wouldn’t have made any difference to the number of babies she could have. I thought I had at least another five years until I needed to worry.’ If you are showing signs of being peri-menopausal (you aren’t actually classified as menopausal until you haven’t had a period for a year), the first test your GP will usually do is for FSH (follicle-stimulating hormone), a hormone produced by the pituitary gland at the base of your brain. As the supply of eggs dwindles, this goes up. A result of 10 and under is usually considered fertile. ‘But it’s a very imprecise tool for looking at ovarian reserve,’ says Professor Ledger. ‘By the time FSH has reached over twelve, in many cases ovarian reserve has gone down very substantially.’ Two more accurate ways of measuring ovarian reserve are the antral follicle scan, which counts the number of potential follicles in your ovaries each month, and a blood test for AMH (anti-M?llerian hormone), a hormone that’s directly released by the follicles in the ovary. Even if your AMH is low, it doesn’t mean IVF won’t work. ‘But it is a warning sign you may not have a good response,’ says Professor Ledger. • • • • • • • • • Toni, a sales manager from Manchester, had just married David when she was told, aged 31, that she was close to the end of her fertility. Two weeks after David and I got back from honeymoon, I called my mum, to say that my period was two days late. David and I had agreed to try for babies at some point in the next few years, but I was surprised it had happened without us trying. ‘Well, I’d rather be pregnant now than find out in two years that we can’t have children,’ I said, and we laughed. But my period came a couple of days later. Before the wedding, my periods had been very regular and I’d never even had PMT. Then, I started to feel really down, which isn’t at all like me. And I was having hot flushes, too. When I mentioned it to friends, they said I was probably having post-wedding blues, a comedown after the big event. I went to see my GP, and mentioned, jokingly, that it might be the menopause. I was only 31, after all. He did some blood tests and rang me the next week while I was driving to work. I put him on speakerphone and heard him say, bluntly, ‘Actually, it is the menopause.’ He told me that my FSH was 68, when it should be 10 or below. Then he said, ‘In fact, that level is post-menopausal.’ It was such a huge shock. I remember it was pouring with rain, the windscreen wipers were going, and I couldn’t seem to see to process the news. At home, David comforted me, and promised me everything would be fine. But I couldn’t even look at myself in the mirror because I’d think: that’s a menopausal woman. How can I look so normal, when I’m not? My GP referred me to hospital for more blood tests and scans. The results confirmed what he’d told me: menopause. The fertility specialist told me there was nothing they could do. She said we could try IVF, but we probably wouldn’t succeed as my problem was going to be getting eggs. And there was no way I had two years of fertility left to wait on the NHS list. She suggested the Lister Fertility Clinic in London, as they specialise in IVF for women with menopausal hormone levels. ‘But if you want to get pregnant really your only option is egg donation,’ she said, ‘so I suggest you have counselling for that.’ That was too hard to accept, that our only way to have a baby would be with someone else’s eggs. I knew David was upset, scared that we’d never have children too. But he didn’t show it; he just tried to be strong for me, because I was so completely devastated. The fact my body didn’t work was all I could think about. I felt half a person and guilty — as if I’d let David down, and I wasn’t the woman he married. I fantasised about running away from everyone, emigrating to the other side of the world, alone. But the sensible me thought, I want David to have a child, and I want my parents to be grandparents. I had told Mum and some of my closest friends my diagnosis, and they were brilliantly supportive. Between them and David, I managed to keep going. It was taking months to get appointments on the NHS so I went to see a private gynaecologist, who did more blood tests. For a change, a nice surprise: my FSH had gone down to 10. So I wasn’t totally menopausal. In fact, over the next year, my FSH fluctuated between 2 and 60. It wasn’t all good news, as my oestrogen was high when my FSH was low, another menopausal sign. But, the gynaecologist said, the official definition of the menopause is a year without a period, and I was still having some periods, which meant I was still ovulating, if only sometimes. So, in fact, I had what’s called premature ovarian failure (POF), and there was hope. ‘It just means it’s going to be very, very difficult for you to get pregnant and to keep the baby,’ the gynaecologist said. My next test was a scan of my ovaries, called an antral follicle count, where they look at the number of possible follicles developing that month; it’s an indicator of your ovarian reserve, how many eggs you have left. My right ovary was inactive and very small. (When I was 16, I had a cyst removed from it, and I don’t think it had worked since, even though doctors told me it shouldn’t have made a difference.) But, amazingly, the scan showed I was about to ovulate from my left ovary. We were delighted, and set about making a baby that night. Two weeks later, I did a test and I was pregnant. It was absolutely brilliant, a huge relief. I thought to myself: what are they all talking about? Menopause? What nonsense. Not only was I pregnant, but the pregnancy hormones overtook the menopausal ones so, for the first time in ages, I actually felt normal. At seven weeks, I had a private scan, and saw the heartbeat. But at 10 weeks, I went for a scan at the NHS fertility clinic and, after looking for a minute or so, the woman scanning me said, quite casually, ‘There’s no baby’. I said, ‘Oh yes there is, I know I’m pregnant, I’ve seen the heartbeat.’ ‘No,’ she said, ‘there’s no baby.’ David wasn’t with me; I’d thought this was just a routine NHS appointment. It hurt so much, I wanted to scream, ‘Do you realise what this means? You’re telling me my only chance of getting pregnant has ended in a miscarriage.’ I put on my knickers and tights, went to the toilet, and threw up everything I’d eaten that morning. It turned out the baby had died around seven weeks, shortly after the first scan. I was given the choice of pills or an operation to remove what was left. I went home, took the pills and waited. The bleeding was really heavy for a week, then stopped, then started again. I went to see my GP about the bleeding, and again a few weeks later, but I was told it was normal. For two months, I bled really heavily, huge clots, every day. Eventually, because I’d become so anaemic, I passed out at my sister’s house the day before Christmas Eve, and had to be rushed to A & E. It turned out a bit of the pregnancy tissue had been left behind, and it was signalling to my body that I was still pregnant. I had a D & C (dilatation and curettage — where my womb lining was scraped out, including the left-behind pregnancy tissue) under general anaesthetic. It felt as if I’d used up my last egg and our one chance to have a baby. Every period after that was a mixed blessing: I’d think it might be my last one, but at least it meant I had ovulated again. I booked in for an IVF consultation at the Lister. I saw Mr Hossam Abdalla, the medical director, who was realistic, but not as fatalistic as previous doctors I’d seen. He put my odds of getting pregnant at 5 per cent, with a high chance of a miscarriage. A lot of clinics won’t even take on patients with POF. (The problem is that the drugs they give you during IVF to boost your egg production are, in fact, the same hormone — FSH — that your body is overproducing because of the menopause.) Mr Abdalla said that giving me extra FSH might not make me ovulate, but it would be my best chance of getting pregnant, and at least I’d be closely monitored. So we embarked on IVF with the highest amount of drugs possible. I wasn’t hopeful. I knew the odds were against me, but I was really determined. I kept thinking of older women who get pregnant, like Cherie Blair. My mantra was: ‘As long as there’s one egg, I can get pregnant.’ I enjoyed the whole process of IVF. I’m not a control freak, but I liked the fact that, for the first time in ages, I knew exactly what was going on. By now, my menopausal side effects — feeling exhausted, hot flushes, brain fog, being so angry I wanted to chuck things out of the window — had got so bad that I actually felt better taking the IVF drugs. Scans showed I had three follicles growing on my left side (and I only needed one, I kept telling myself). But when it came to egg collection, only one egg was mature enough and it was damaged. So that was the end of that. We licked our wounds, and decided to carry on. I was absolutely not going to give up. For as long as I was ovulating, we were going to try. By then, I’d read everything I could find on fertility, gone completely teetotal, given up caffeine and switched to organic food. I’d started to have weekly reflexology and acupuncture too. I felt panicky though, as no matter what I did, my periods — and so ovulation — were beginning to get less regular. Sometimes two months would go past without any sign of one. I carried on at the Lister, doing cycle monitoring, so we’d know the best time to have sex. But treatment wasn’t cheap; we’d already spent around ?7000 on IVF, ?100 a week on reflexology and acupuncture, ?100 a scan and more for blood tests too, and I knew we couldn’t carry on spending this kind of money indefinitely. At the time, it seemed as if all my friends were getting pregnant around me, as if I was surrounded by bumps and prams. And I had this feeling of guilt that was weighing me down all the time. I was putting on weight and every time I had a hot flush, a fit of anger or woke up at 5 a.m., it was a reminder that I was menopausal and couldn’t get pregnant. My only consolation was the thought that if I didn’t get pregnant, we could try egg donation or adoption. I wasn’t ready to stop trying for my own biological child just yet, but not having children at all wasn’t an option. That September, six months later, we started a new cycle of IVF. I did the injections for the usual two weeks but there was no sign of a single egg this time. Another full week of injections later, there was finally one egg there. I was fully expecting that we’d have to abandon the cycle completely. And, as I’d expected, the doctor advised us that the risk of damaging our only egg by taking it out was too high. But he had an idea: he suggested that we do IUI, where David’s sperm would be put inside my uterus at exactly the right moment. Great, I thought. At least we have one option. So I did the injection to make me ovulate, started on progesterone suppositories, and we had the IUI procedure two days later. I put the fact that I had begun to feel different down to the progesterone. But two weeks later, on New Year’s Eve, I decided to do a pregnancy test (it was a couple of days early, but I wanted to know if I could drink, after being teetotal all year), and it was positive. It was a brilliant New Year! Still, in the back of my mind, I knew the pregnancy wasn’t safe. David used to phone me from work every day and ask me how I was feeling, going through a checklist: still feeling sick? Yes. Still got sore boobs? Yes. After my 12-week scan showed a healthy baby, I did start to relax, though not completely. I loved being pregnant, the novelty of it and feeling special. I didn’t take one second of it for granted. I hope I never complained about it. But just the slightest thing — bleeding and, later on, not feeling the baby move — sent me straight to the hospital for checks. It all went well though and, in September, Charlie was finally born: our dream come to life, a gorgeous little lad. My periods became pretty regular after I stopped breast-feeding Charlie at six months, so I felt positive about getting pregnant again, and we started cycle monitoring again. We do know how lucky we are to have Charlie, and I don’t want to sound ungrateful, but we both would have loved a brother or sister for him. If the pre-baby me had heard me saying that, I’m sure she would have told me to shut up and just appreciate what I have! But there is a sense we haven’t finished our family, and I hate the thought of both of us being a burden to Charlie when we’re older. When Charlie was 14 months, I did get pregnant, but it ended in a miscarriage at 10 weeks. Now, he’s four and starting school. I thought I’d get pregnant again naturally, but we haven’t managed it. Things have really slowed down for me hormonally, and I have gone four months without a period. Six months ago, we tried injecting fertility drugs again to see if I could get an egg, but it didn’t work. David struggled for a couple of weeks after that, coming to terms with the fact we won’t have any more children who are fully related to us and Charlie. Now, egg donation really is our only option. I’m on the list at a clinic in the UK, but I’ve got mixed feelings. I am most of the way to accepting that Charlie will be an only child, and to seeing the good side of that. It’s not what we would have chosen, but it’s definitely enough. Q: WHAT HELPED YOU COME TO TERMS WITH YOUR DIAGNOSIS? I didn’t accept or come to terms with the diagnosis of an early menopause until very recently. Instead, I ? xated on getting pregnant. One doctor told me that your ovaries can sometimes stop working temporarily, and then restart again. So that is what I chose to think. My desire to get pregnant was stronger than the horror of facing an early menopause, so I let that be my overriding emotion. I found out that Premature Ovarian Failure happens to one in a hundred women, and it was enough to know that I wasn’t alone, without having to speak to anyone who was going through the same thing. I did look at support group websites for women with Premature Ovarian Failure, such as the Daisy Network, but only to see if there were any success stories. When I couldn’t ? nd any, I stopped. Q: WHAT IS YOUR ADVICE TO ANYONE WITH PREMATURE OVARIAN FAILURE? Get the symptoms treated. A month ago, I got a private referral to a doctor who specialises in POF. I had avoided doing anything about my menopausal symptoms as I hadn’t wanted to interfere with getting pregnant. But I thought, enough is enough – it’s time for HRT. My doctor prescribed me bioidentical HRT – body-identical forms of oestrogen and progesterone. He told me that, if it made any difference at all, HRT might have increased my chances of getting pregnant. In ? ve years, no one had mentioned that. And, two months into taking the hormones, I feel a lot more human. Q: WHAT’S YOUR VIEW ON EGG DONATION? I’d say, don’t rush into it. It’s a big step and one that needs to be thought about carefully. And you’ve got time because it’s the donor’s fertility that matters, not yours. I would definitely tell any child conceived by egg donation that he or she was a donor baby. But, after having Charlie, I can’t make up my mind if it would be fair to have a child who wasn’t fully related to him. Would he look like Charlie? I’m dark, but Charlie is blond and blue-eyed like David, so my own biological child looks nothing like me! I’ve no doubt I’d love the child, but how would that compare to my love for Charlie? Then I think, well, David’s family are all utterly gorgeous, and the child would be fully related to them. I’d be carrying the baby for nine months then, when the baby was born, nursing him or her. I’d probably be too busy to worry about whose eggs helped make the baby. We have been offered three possible donors so far, who are egg-sharers, which means they’re willing to give away half their eggs in return for most of the cost of their IVF treatment being paid for by the recipient of the eggs. But we’ve rejected all of them. The first two were blonde, and that was what put me off. Then I changed my criteria to dark-haired women only, and the perfect person came up: educated, brunette, in her early 30s. But David and I talked it over, and decided to say no. It feels quite ? nal, but we haven’t said never. Q: WHAT WAS THE MOST USEFUL ADVICE YOU WERE GIVEN? To be honest, all the doctors were quite negative, though I suppose they were only being realistic. My friends and family helped by telling me that I’d got pregnant once, and so I could do it again. Going to see a re? exologist was a great support, too. She used to remind me that I was still ovulating sometimes, that I wasn’t fully menopausal. • • • • • • • • • If you still have periods, some clinics will perform IVF with your own eggs, even if you have high FSH and/or low AMH. Your chance of success, of course, is low, but there is a chance as long as you’re ovulating. The Lister Fertility Clinic in London (ivf.org.uk), for example, specialises in this category of women, and recommends that you start treatment as soon as you can after diagnosis. Create Health (also in London) treats women with reduced ovarian reserve. The medical director, Dr Geeta Nargund, believes that a lower-dose drug regime is often more successful in such women (see createhealth.org and Chapter 9). The main UK charity for premature ovarian failure is the Daisy Network. They hold an annual conference with speeches by experts in premature menopause. Their website (www.daisynetwork.org.uk) has information on IVF using donated eggs, as well as adoption, surrogacy and being ‘positively childless’. Another good source of information on donated eggs is the Donor Conception Network (donor-conception-network.org). See pages 172—3 for more information on egg donation. And make sure you tell your doctor that you’re considering egg donation, as it may affect your treatment for menopausal symptoms. The International Premature Ovarian Failure Association (ipofa.org) has a useful factsheet too. And you may want to see a counsellor or consider therapy. To find a counsellor or therapist, go to bica.net, bacp.co.uk, psychotherapy.org.uk and bps.org.uk. I couldn’t give my son a sibling • • • • • • • • • • • • • If conceiving your first child was as simple as putting your Pill in the bin, or was even a happy accident, finding out you can’t get pregnant again can be harder than you’d imagine. Fertility coach, Anya Sizer, says that women often assume they should pull themselves together when they already have one child, and that not having a second or third can be dismissed as less upsetting than having no children at all. The poor relation of primary infertility, if you like. ‘I don’t think there’s much sympathy for women with secondary infertility,’ she says. ‘Maybe you’re at the school gates being a mum, so people assume you should be fine. When that was me, I was very grateful for my first child, but the fact I couldn’t conceive for a second time still made me feel as if I was walking around with a black cloud over my head.’ For a woman who desperately wants that second child, but can’t get or stay pregnant, it can feel as if there is a huge hole in her family. ‘In fact, secondary infertility can be harder to accept than primary infertility,’ says Dr Lee Lim, Consultant in Obstetrics and Gynaecology, Oxford Fertility Unit. ‘And families who really want a sibling for the first child are under extra pressure when they compare themselves to friends who are having their second or third baby.’ There are lots of reasons for not wanting a single-child family: maybe you didn’t like being an only child yourself, or you come from a big family. Sadly, secondary infertility is as common as primary. ‘Of those who had no problems getting pregnant the first time around, around 15 per cent have problems the second time,’ says Dr Lim. Of course, it’s not officially infertility until you’ve been trying for a year, even if you got pregnant easily the first time. ‘You need to give yourself a year before you label yourself as having a problem,’ says Dr Lim. ‘Often, people who come to see me are anxious, and I need to explain that each month, their chances of pregnancy are only 30 to 35 per cent.’ Secondary infertility is also less likely to be due to underlying physical issues than primary infertility. ‘The family dynamic can change after a first baby, so you may not have intercourse so often,’ says Dr Lim. ‘Or you could have experienced a difficult birth, which can be a very good natural contraceptive, as childbirth is so intimately related to the birth canal. You might not realise that you’re avoiding sex or why. One sign of childbirth trauma is that you may have had a problem in attaching with your baby. A gynaeocologist isn’t always the best person to help you talk about this; a counsellor can be better.’ Having said that, there are often physical reasons for secondary infertility. If you have a new partner, it may be down to his sperm (although that’s not strictly secondary infertility). If you’re still breastfeeding, you may not be ovulating regularly. Another risk is scar tissue in the uterus, which can happen if you have an operation, post-miscarriage. ‘A telltale sign is that your periods have changed after this procedure,’ says Dr Lim. Or it could be that you have or have had an infection that has blocked your tubes. Secondary infertility can also be caused by problems with your previous pregnancy and delivery, including infection, as well as other problems such as endometriosis, PCOS and fibroids. But the reason that surprises most patients, says Dr Lim, is that a woman may be less fertile because she’s put on weight after having a child. ‘If your body mass index [BMI — a calculation that assesses your weight, taking into account your height] is over 30, it’s much harder to get pregnant.’ Weight is often an issue for women with PCOS, as weight gain is part of the syndrome. ‘Even if we have been able to help a woman with PCOS ovulate the first time around using medication if, by the time she is trying for her second baby, she has put on weight, it gets much harder,’ says Dr Lim. Finally, there’s the question of age. If, for example, you had your first child at 35, by the time you get round to having your second or third, your fertility will have reduced naturally. ‘It’s not uncommon now for women to try for their second baby at 40 and, at that age, it’s always going to be more difficult to get pregnant,’ says Dr Lim. And, as your fertility is uniquely personal, it could happen earlier too. Abby, who tells her story below, got pregnant easily at 33 but, just two years later, found she couldn’t get pregnant again. The investigations for secondary infertility are the same as for any infertility, and may include blood tests and scans to check hormone levels and that you’re ovulating properly, an internal examination and tests to check your Fallopian tubes are still working. And your partner will need a sperm test, as both quantity and quality can decline with age. • • • • • • • • • It wasn't until Abby, 37, a TV producer and writer from London, started trying for a second baby that she had problems. I didn’t even have to think about whether having two children was right for John, my husband, and me. I had always envisaged lots of kids running around. It took around seven months for me to get pregnant with Jake, my first baby, when I was 33. I really threw myself into motherhood and loved it so much that I remember thinking, five months in, I really want this again. So when Jake was 14 months, we started trying for a second baby. But, month after month, I didn’t get pregnant. I started using ovulation kits and, I admit, became completely obsessed with pregnancy. It was all I wanted and it consumed my thoughts. At any given time, if you’d asked me, I could have told you exactly where I was on my cycle. The two weeks after ovulation were the worst, when I’d constantly be thinking about whether I was pregnant or not. But the signs of being pregnant are the same signs as getting your period — for me, bloating and tender breasts — so every month, it was a mental and emotional nightmare. On the day of my best friend’s wedding I was due to get my period and spent the whole day wondering if I would come on or not. Of course, I did. Whenever I got my period, I’d have an awful crash. It was as if I was properly, clinically depressed; I would go back to bed for the first and second day and cry for most of the time. I remember coming down for breakfast and sobbing and sobbing in front of John. He was understanding, but he couldn’t really comprehend the heady combination of a bitter disappointment plus a hormonal crash that made me feel so low. Sex became something that was difficult to deal with as a couple. Exactly when I ovulated began to control our sex life. Scheduled sex is like sitting down to dinner when all the food is ready, but you’re not hungry. We were no longer a normal couple having normal sex, because I was always thinking about the end goal. Like me, John wanted two children but he would have been absolutely fine to wait a year and see what happened. So why did I get into such a fertility frenzy? There were a few reasons. We seemed to be surrounded by lots of breeding people. Because my friends (in fact, my generation of women, in general) were starting their families slightly later, everyone I knew was having their babies close together, one after the other. Unable to do the same, I saw myself as desperate, and felt that other people were looking at me, pitying me, thinking: poor her, she can’t conceive again. Also, having got pregnant relatively easily before, I couldn’t understand why it should be taking so long this time. Plus, not only was I thinking about pregnancy all the time, I’d met a few other mums who were having problems the second time too, so I’d begun to talk about it all the time. Life became all about pregnancy. I was reading different advice on the internet every day, taking handfuls of various supplements, having fresh wheatgrass juice every morning and weekly reflexology and acupuncture sessions. Looking back, it had become a full-time job. I couldn’t stop thinking that there must be something we weren’t doing which could increase our chances. A year after we started trying, I made an appointment at a fertility clinic for us to get checked out. John’s sperm was a little bit below par, but not too bad. My tubes were clear and my FSH was under 10, but when the doctor did a scan to look at my antral follicle count, to see how many potential follicles I had that month, I only had one or two on each ovary. He told me that my ovaries looked more like those of a woman in her mid-40s, and I was only 37. Then I had an AMH blood test, another way to measure ovarian reserve, and my level was classified as ‘low’ too. That took the stress up a notch. Finding out there was actually something wrong was very emotional. It began to look less and less likely that I’d get pregnant. As my tubes were open, so — in theory — the sperm could travel to fertilise the egg as in a natural pregnancy, doctors told me I might not need IVF, but was a good candidate for stimulated IUI (where you do hormone injections, the same as IVF, and on the day your eggs are ripe, they insert the sperm into your womb). Injecting the drugs made me feel out of it, not quite on this planet. Even though I was open with close friends about having treatment, I still felt very alone. And I had to carry on with life as normal, looking after Jake and the house. It was a strain, though, and I remember on one occasion having a huge argument with my mum. I complained to her that Jake was being difficult, and she said it might have been because he was picking up vibes from me. I over-reacted and got really angry, telling her she was out of order. The first cycle, I over-responded and produced too many eggs. That meant I had to have a horrible procedure called aspiration, where they pop the follicles via a tube that goes into your womb through your cervix. I was awake the whole time, and it was grim. I don’t think I’d realised what I was getting myself into with the stimulated IUI cycles. It was much more medical and full on than I’d expected. What was amazing though, is how John and I totally came together once we’d started treatment. It became one of the best times of our relationship. He kept telling me it was the right thing to do, and I felt really supported. John never questioned any of the bills either. We were spending so much money, it didn’t seem real — ?700 one day, ?500 the next. What struck me about fertility treatment is that if it doesn’t work, it feels like a complete waste of money. If it does work, it’s money very well spent. After all, I’d rather have a baby than a new kitchen. After three IUIs in four months, I started pushing the doctors to recommend IVF because the success rates are so much better than IUI. People say having IUI prepares you for IVF and I think it does; I had got used to the side effects of the drugs, and all the intrusive and personal medical procedures. The lead-up to IVF was quite an ordeal, even before I started the drugs. I had to have a hysteroscopy; my doctor told me that it’s not certain why, but having this procedure can help to improve the chance of implantation. The doctor also did a dummy run to check my cervix was going to be open enough for transfer by inserting a tube into it and leaving it in for a few hours. Having found the IUIs so traumatic, when it came to IVF I really tried to prepare for it, to get revved up mentally and physically. I was scared (mainly, that it wouldn’t work), but I tried to put a lot of positive energy into every procedure. I’d read a lot about whether the mind can make a difference to fertility. Even though I didn’t wholly believe it, I thought, there’s no harm in being positive. But I was up or down with every piece of good or bad news. Every day was a roller-coaster on IVF, not only because it’s so important to get right, but because the drugs were making me spaced out too. John was more positive. He saw IVF as a solution and he wasn’t scared of it. Although he thought it might take more than one go, he also believed there was no reason why the clinic couldn’t help us. He was determined to persist with treatment until we got what we wanted. At my first scan, they only saw six follicles developing, and the doctor in charge of me said that ideally they’d like to see more. He said I was a ‘slow responder’, explaining that it was as though my ovaries were deaf, and needed more drugs to ‘hear’ the message. This was a real blow. The doctor immediately maximised my drug dosage, but not only was I disheartened, I was now terrified it wouldn’t work. Afterwards, I spoke to a friend of mine who’d done IVF and had got pregnant, and she’d only had three eggs harvested; that made me feel better, and three eggs became my benchmark. Every day, I did what the doctors said without questioning it. It’s quite invasive and personal, to give someone else the task of getting you pregnant, and it all felt quite mechanical — like being on a conveyor belt — but I trusted that the doctors were doing the best they could for us. On the day that snow brought the whole of London to a standstill, and a friend had her operation for a brain aneurysm cancelled, the fertility clinic was open, having picked up key staff around London with a helicopter. I forced myself to view the side effects of the drugs — fuzzy thinking, tiredness — as positive, proof that something was happening. I had some bloating and my ovaries felt strange, but I told myself it was all good. By the second or third scan, things weren’t looking quite so dire, as I’d gone up to eight follicles. Having the egg-collection operation was quite surreal, especially being with all the other women in the ward before and afterwards. It was odd to be sharing such a crucial moment in our lives with strangers. But it was also quite exciting. We all wished each other good luck. When I came round from the anaesthetic, the doctor told us that every single follicle had yielded an egg — that meant we had eight, which was amazing. From then on, it became like a dream IVF cycle. Every day, the embryologist would telephone me and say positive things about the embryos. In the end, every single one of them lasted five days and went to blastocyst. Before transfer, there was some debate about whether we should have one or two embryos put back. The embryologist was pushing for one, as the embryos were such good quality, but the doctor said we could have two. Faced with that decision in a more rational state, I’d have gone for one; as John pointed out, we already had one child, and having twins wouldn’t have been practical. But at the time, I’d got myself into such a state about not being able to have a baby that I was completely up for a multiple pregnancy. I didn’t even consider the medical issues for me or any babies, such as that a twin pregnancy has a higher risk of miscarriage and complications. I just desperately wanted a child or even children. In the end, I did have two embryos put back in. One was top grade, and the other was almost as good. Transfer was horrible: I got really cold because they told me to drink what felt like gallons of water, there was no heating on and I was only wearing a flimsy gown. John did his best to keep me calm and warm. People say the two-week wait is the hardest part, and it is. Suddenly, from doing injections, having scans, taking phone calls, you’re on your own and there’s no contact with the clinic. For the first three days, I stayed in bed while Jake was at nursery. One day, I’d think I was feeling pregnancy symptoms, then the next day, I wouldn’t. It was like all those months when I’d hoped I was pregnant, but much more loaded. The night before the pregnancy test, I couldn’t sleep. I got up at 6 a.m. and did it in the bathroom. It was positive. I couldn’t quite take it in. I went in and got into bed with John and woke him up and we hugged. It wasn’t until I went into the clinic later that day that it really sank in. I went to the six-week scan convinced it was twins. But there was only one heartbeat. It was a shock — I’d thought it would be all or nothing. The staff at the clinic and John were really delighted, but I kept thinking: what happened to the other one? It’s strange, as I had a sense of loss, and even though I know it’s better to have one baby at a time, I still think about the other possible baby to this day, whenever I look at beautiful Edie, who’s now six months old. The embryos turned out to be such good quality that we’ve got six blastocyst embryos on ice. I’m very grateful to have Jake and Edie, but I don’t know if I’m up for having a third child yet — or ever. We haven’t decided what we’ll do with the embryos; maybe we’ll donate them to medical research. Q: HAD YOU HEARD OF SECONDARY INFERTILITY BEFORE IT HAPPENED TO YOU? I knew some people struggled with miscarriage, but I assumed that if you’d had one child and wanted a second within a couple of years, you’d be ? ne. I didn’t really listen to talk about declining fertility; I thought it alarmist when I heard doctors saying that after the age of 35 your fertility ‘falls off a cliff’. Certainly, I will tell my children what happened to me, so they can make up their minds about when to try for their own family. Q: WHAT’S YOUR ADVICE TO SOMEONE WHO’S STRUGGLING TO CONCEIVE AFTER HAVING A CHILD? People say, ‘Oh, you have a child, you should be grateful.’ And yes, you are so grateful, but you are also devastated to think that might be it. It’s important to acknowledge what you’re going through; I think the frustration and disappointment must be every bit as acute as not being able to conceive the first time. If you already have a child, you know what you’re missing. And your idea of a family is being torn to shreds. You have to keep plugging away with trying, giving yourself breaks from treatment when you need to, as it’s very intense. Most importantly, keep the faith. My husband helped me with this. And now we have a daughter, we are just so delighted and grateful, with her, for ourselves and for Jake. IVF made the experience of her so much more special – a reward for all our hard work. Q: WHAT’S YOUR ADVICE TO SOMEONE WHO’S CONSIDERING HAVING IVF FOR SECONDARY INFERTILITY? Don’t be scared of it. It’s perceived in society as a much bigger deal than it really is. When you’ve got to the point that you need IVF, you’ve done a lot of the hard work by having all the fertility tests and maybe IUI. You’ve already been sad and had to deal with a lot of uncertainty. Before I had IVF, I had the attitude that it was high-tech and unnatural, but it’s really not that bad. The best way to think about it is simply that IVF gives you a better chance. Q: WHAT PRACTICAL THINGS HELPED YOU TO GET THROUGH IVF? Much as I hated having the IUI cycles before IVF, they gave me an opportunity to learn what not to do during IVF. I tried to live as normal a life as possible during IUI – for example, I was in the pub all afternoon on my birthday, when I should have been resting. But when it came to IVF, I focused on it completely and didn’t let anything get in the way. Also, at first I tried every complementary therapy going, but, by the time I got to doing IVF, I knew what was working for me – acupuncture. I tried to be really healthy but not obsessed, so, very occasionally, I’d have a small glass of wine. I also tried to stay calm. Q: IS IT A GOOD THING TO TALK TO FRIENDS ABOUT WHAT YOU’RE GOING THROUGH? I found it was a release to let people know what we were doing. That said, at some points it’s better to get on with things yourself and not talk about them so much. Sometimes, with other women who are also trying to get pregnant, it can become destructive, as you end up comparing yourself to them. I had one friend who I con? ded in, who was going through the same thing, and who was incredibly supportive. • • • • • • • • • There’s not nearly so much written about secondary infertility as primary. Fertilityzone.co.uk have a dedicated secondary infertility section on their forum and reading the posts shows how difficult it can be. One mum says, ‘I am so glad to have my son, he is my life and I wouldn’t want to be without him, but I can’t get rid of this agonising pain in my heart. I want another baby I so desperately want my son to have a sibling.’ Fertility Friends (fertilityfriends.co.uk) also has a very busy thread on their forum for secondary infertility. In their explanation of secondary infertility, the National Infertility Association in the US, Resolve (resolve.org), describe all the aspects in a very perceptive way: ‘It’s a cruel irony that the more positively parents feel about parenting, the more painful is their experience of secondary infertility’ (www.resolve.org/diagnosis-management/infertilitydiagnosis/secondary-infertility.html). They also bring up the issue of how wanting another child and having treatment can affect the child you already have. Lynda, 42, blogs at http://tryingfornumbertwo.blogspot. com/ about almost five years spent trying for a sibling for her daughter, who she conceived after only three months. She is appealingly honest: ‘It seems so unfair that for most of my daughter’s life I have been grieving for an unborn child. I really feel that my grief has overshadowed the joy of having my beautiful daughter.’ Kathy Benson, now mother to Sean and Abby, went through four years of secondary infertility and documents her journey in her blog, chicagobenson. blogspot.com. ‘I especially had a hard time’, she writes, ‘when friends and family members would announce their pregnancies publicly at social gatherings.’ She also makes the point that women with secondary infertility tend to be surrounded by reminders that they can’t conceive because they are so often around children and other mothers. The book she found most useful was Conquering Infertility: Dr. Alice Domar’s Mind/Body Guide to Enhancing Fertility and Coping With Infertility (Penguin Books). On the practical side, Infertility Network UK has a factsheet on secondary infertility, available at infertilitynetworkuk.com. Sadly, if you already have a child, it’s very unlikely that fertility treatment such as IVF or ICSI will be NHS-funded. Cancer affected my fertility • • • • • • • • • • • • • It seems particularly unfair that if someone has endured the uncertainties of cancer and the difficulties of treatment, that she or he could also end up infertile too, as a result. Sometimes the cancer itself is to blame, but more usually it’s down to surgery, radiotherapy and/or chemotherapy. Fertility preservation is now usually offered before cancer treatment. For men, sperm can be frozen and stored before treatment, then used in IVF, usually ICSI. If sperm wasn’t stored — for example, if the man had cancer in childhood — then he may be able to have sperm extracted from his testes during an operation, frozen, then the couple can have ICSI later on (see Chapter 2). The most tried-and-tested fertility preservation technique for women is to have IVF prior to cancer treatment, and the embryos frozen, to use when you’re better. ‘Of course, this is not always possible if the patient doesn’t have a partner,’ says Mr Tarek El-Toukhy, Consultant and Honorary Lecturer in Reproductive Medicine and Surgery at Guy’s and St Thomas’ Hospital NHS Foundation Trust. If that’s the case, she may have the option of freezing her eggs, though this is less established and, until a few years ago, fewer eggs than embryos survived the freezing and thawing process. A new freezing technique called vitrification has boosted the thaw rate of eggs; recently, the first two British babies were born from eggs frozen using this technique, at the Midland Fertility Services clinic. If the cancer has a hormonal element, as some kinds of breast and ovarian cancer do, or the cancer needs immediate treatment, IVF beforehand might not be possible. ‘In some cancers, it’s not safe to have ovarian stimulation,’ says Mr El-Toukhy. ‘There are other options we can offer, including preserving ovarian tissue by freezing it. But at this stage it is experimental, and very few babies have been born from it worldwide.’ The idea of this treatment is that the ovarian tissue can be put back inside the woman’s body to grow eggs when she’s well, or in future, the immature eggs inside the tissue might even be matured in a test tube and used in IVF. Of course, there is no guarantee that any assisted reproduction technique will work. ‘The clinician has to talk to the patient openly about what treatments they can offer, and the realistic chance of achieving a pregnancy,’ says Mr El-Toukhy. ‘But you could argue that a chance is better than no chance.’ Some women do still have functioning ovaries after treatment for cancer, which means they can have IVF if needed, or even get pregnant naturally. ‘There are a lot of factors that affect whether the patient retains her ovarian function — the type of cancer, the age of the patient and her ovarian reserve, whether she had surgery, radiotherapy and chemo-therapy, the type of chemotherapy, the number of courses of chemotherapy and, of course, how badly the cancer has affected her general health,’ says Mr El-Toukhy. If cancer does affect fertility, there may be the option of egg donation or surrogacy. Sadly, although IVF and embryo freezing are routinely provided on the NHS, the rest of these treatments often need to be paid for. • • • • • • • • • Lucy, 32, a hospital manager from Hampshire, thought she might never have her own child after cancer. My husband John and I came out of the hospital, got straight into a cab and went to have a slap-up celebration lunch in Gordon Ramsay’s restaurant in Chelsea. We had good reason to celebrate: we’d just been told that we could go ahead with IVF and surrogacy. Just 10 months earlier, I’d been diagnosed with a rare form of cancer in my womb. I hadn’t even been sure if I’d still be around, and hadn’t dreamed I’d be fertile. It had all started two years before, when John and I had been delighted to find out that I was pregnant. But I had the worst morning sickness, constant vomiting and no energy. I couldn’t eat or drink anything without throwing it up. I felt hungover, but multiplied by a million. When I went for a scan at 10 weeks, the sonographer could see immediately that there was something wrong. In place of the expected embryo, there were a lot of fluid-filled cysts, like a little bunch of grapes. The doctor came in and said, ‘I’m sorry, but there’s no baby.’ He told me I had a molar pregnancy, where the fertilisation of an egg goes wrong, and it turns into a mass of cells that grow very rapidly, but don’t form the foetus and placenta of a normal pregnancy. It would need to be surgically removed. He added that there was a 10 per cent chance that the cells would continue to grow after surgery — a rare form of pregnancy-related cancer. We were so hung up on there being no baby that we couldn’t take in the cancer part at first. Later on, a more senior doctor explained it to us again, and two days later, I had an operation to remove the molar pregnancy. Though I was upset about losing the pregnancy, I was relieved when the surgery was over. But, two weeks later, I started getting really strong abdominal pains, and I was admitted to hospital and prescribed morphine. The next day, I was transferred to Charing Cross Hospital, the national screening centre for molar pregnancy, where I had every kind of chest X-ray and chest and abdominal CT scan. The first thing the consultant there said to me was that I had cancer. Molar pregnancies produce incredibly high levels of beta hCG, the pregnancy hormone (that explained my awful morning sickness). After having the molar pregnancy removed, my level should have gone down to zero, but lab tests showed it was still close to a million (in a healthy pregnancy, it wouldn’t normally go above 280,000). I was one of the unlucky 10 per cent whose molar pregnancy had turned into a form of cancer. On the ward, away from home, I felt lonely and scared. And I was still in pain. But the doctors were upbeat about my chances: they told me that chemotherapy had a 99 per cent success rate. I started having chemotherapy every two weeks — injections of a drug called methotrexate that would kill the remaining abnormal placental tissue. It took five months for the chemotherapy to work, for my hCG levels to get back to normal. The side effects weren’t too bad: my eyes were sore and I felt a bit tired and run down, but it was bearable. I was told not to get pregnant for a year, as the hCG produced by the pregnancy would interfere with my monitoring. That was hugely frustrating, as John and I wanted to get on with life. I went back to work as a hospital manager and we decided to make the most of the year: I went on a spending spree: I bought a brand new Mazda MX5, spent a fortune on manicures, pedicures, fake tans, massages, handbags, designer shades, ate out at some swanky London restaurants and went to the theatre, the British Grand Prix and to see Chelsea, John’s favourite team. We also booked a holiday to the Maldives — something else to look forward to. But we never got to go. My abdominal pain came back and I ended up having three operations to treat it that year. First, the surgeon performed a laparoscopy and found that the inside of my abdomen was filled with adhesions (pelvic adhesions are bands of tissue that stick tissue and organs together — a kind of internal scar tissue that can be caused by an operation, among other things). The second time, he had to open me up completely to get rid of the adhesions. That’s when he saw that my left Fallopian tube had come away from my uterus and had got caught up in my bowel. The left ovary had also died because its blood supply had been cut off, so he had to remove it. I was terrified that with only one ovary, my chances of conceiving would be halved, but the doctors explained that it wouldn’t alter my chances, as the Fallopian tube next to my remaining ovary was clear. I tried to move on, but just a few months later, the pain came back. In my next operation, the surgeon removed a blood clot from under my right Fallopian tube. Just a week after the operation, on my 30th birthday, we had an amazing weekend, cocktails and dinner at Claridges. We stayed over in a beautiful room, with a massive marble bathroom and one of those showers where you feel as though you’re standing in the heaviest rain. It was really special. Both John and I thought that I was finally better. Then, a month later, in the run-up to Christmas, I suspected I might be pregnant. I did a home test and it was positive. It was great news, but I was also freaked out and kept saying, ‘I don’t want to get sick again’. I didn’t feel nearly as nauseous as when I’d had the molar pregnancy, which was a good sign, I thought. But, driving on the motorway in the New Year, I felt the most unbearable sharp pain in my abdomen, and thought I was going to pass out. I turned back and drove straight to my GP who suspected it might be an ectopic pregnancy (where the foetus develops in a Fallopian tube), so I was admitted to our local hospital. They monitored my hCG level, to see if it was going up or down. If it was going down, it was likely to be a miscarriage; if it was going up, it was likely to be an ectopic pregnancy. But it stayed exactly the same — a sign that the pregnancy wasn’t viable, but also, possibly, that I might be ill again. I was sent back up to Charing Cross. After lots more scans and tests, doctors told me they suspected I had a much more serious form of cancer. I had yet another operation — keyhole surgery to get a biopsy of the mass they had seen in my uterus on the MRI and CT scans. But what the surgeon saw with the camera didn’t tally with the scans, so he decided to open me up completely, cutting up my womb to remove the mass. And thank goodness he did — 10 days later, we got the diagnosis that I had a cancer called placental site trophoblastic tumour (PSTT), but such a rare type that nobody at Charing Cross had ever seen it before. Because the cancer was so rare, the doctors couldn’t give me a prognosis. Also, the MRI scans had shown abnormalities on my spleen and remaining ovary, and until I’d had the associated lymph nodes taken out and analysed, we wouldn’t know if the cancer had spread. I said to the consultant: ‘Just do what you need to do, but please tell me I’m going to be ok.’ And he said, ‘Unfortunately, nobody knows what the future holds.’ Which was when I realised how ill I was. Treatment for the cancer would be the biggest operation of all — this time a hysterectomy, including removal of my pelvic lymph nodes and my appendix, followed by eight weeks of heavy-duty chemotherapy. We were told that the chemotherapy would very likely stop my remaining ovary from working properly and that I’d probably go into menopause. My consultant suggested that, during the hysterectomy, a slice of my ovary could be removed and frozen. He explained that although it was experimental technology, the ovarian tissue could be used to help me produce my own eggs later on. Having a hysterectomy at 30 is pretty horrendous, as is the thought of an early menopause, but they were minor details considering what I was facing. I was consumed by a horrible fear that I might not survive. At this point, my focus was on getting myself fit and well, and anything else — including having children — slipped into the background. What kept me going was that I had no other option — I knew I had to have the surgery and chemotherapy if I was ever to be well again. Sitting in the hospital bed after the operation, I thought, I’ll just have to get myself better now, get my ovary working and prove the doctors wrong. But I was very ill, and looked so awful that I couldn’t even bear for my parents or friends to come and see me. There was some good news though: analysis of my lymph nodes showed that the cancer hadn’t spread. I can’t find the words to describe how amazing John was throughout the time I was ill. While I was in Charing Cross, he gave up work for six weeks, and was with me every day. A few months before my diagnosis, determined to be well, I’d signed up for the London marathon, and because John hadn’t wanted me to train on my own, he’d got a place too. While I was ill, he kept running; he said it was the best way to clear his mind. Ten days after the operation, I started my cocktail of chemotherapy. The previous chemo was nothing compared to this. One chemo drug combination was given weekly intravenously, and for days afterwards I’d feel unbelievably exhausted. My bones ached, my stomach was upset and I’d long for the days to pass. The other had to be given overnight in hospital, and would knock me out. The first time, I woke up in the early hours of the morning feeling terrible, as if I was being melted from the inside. I begged the medical team to stop the treatment; I cried and cried until I could bear for them to continue again. Once, the chemotherapy leaked from the drip on to my arm and burned my skin, so a plastic surgeon had to cut my arm open and flush through the burned tissue with saline to prevent any permanent tissue damage. With the cuts bandaged, it looked as if I’d slit my wrist. As I couldn’t use my hands, John even washed my hair for me. That was until my hair started to fall out. That made me feel so unfeminine, and reminded me of my illness every time I looked in the mirror. When I had to shave my head, because it looked so patchy and horrible, John shaved his in support. We looked like a pair of hooligans — like the Mitchell brothers from EastEnders! One of the hardest things for me was for friends and family to know how poorly I was. It was difficult knowing that they’d be sad for me. So I kept it all to myself, even though John said I should talk about how I was feeling more. On the days when I felt well enough to go out, John would take me to see friends or we’d pop to the pub. For a few months, I didn’t feel strong or well enough to go anywhere without him. There was a point, he told me afterwards, when he worried that he’d always be my carer — and that’s not what you want at 30. After the chemotherapy, my scans and blood tests showed no sign of the cancer. As far as the doctors were concerned, my treatment was over, though I’d still need regular checkups, and wouldn’t get the final all-clear for five years. It was just a few months later, at one of my check-ups, that we discovered my ovary had started working again, against all odds, and that my ovarian function was absolutely normal for my age, 31. So you can understand why John and I celebrated! I was nervous about the idea of IVF, being pumped full of hormones; and the doctors all said that I’d have to do at least three cycles to expect a result. They told us to wait six months, until my body was ready and, I assume, until I was mentally strong enough too. We booked to go to a conference on surrogacy, to find out more about it. But on the morning of the conference, John’s sister, Sally, texted me to ask what we were up to that weekend, and I told her. That was the first time I’d ever let anybody (apart from my parents) know that surrogacy might be an option. She texted back, saying, ‘You know you don’t need to go because I’d love to help you.’ Sally explained that she’d been thinking about offering earlier, but didn’t want to bring it up as I’d been so private. She had finished her own family — two gorgeous boys aged eight and nine — and seeing me with them, she knew how much I loved kids, and could tell how sad we were, and how desperate to have a family. One night a few weeks later, Sally came over, and I told her everything that had happened. We cried together and discussed how she’d feel if the baby was a girl or if there was something wrong with it. She assured me that she would consider herself simply as the oven, cooking our baby for us. Before we could have IVF, John had to have his sperm frozen for six months as, in the eyes of the law, he’d be a sperm donor. Then, finally, I could start IVF. I couldn’t face another general anaesthetic, so I asked to be awake for egg collection. Although I was sedated, it was very painful. The doctor took out three eggs. All three fertilised, but by the transfer day, only two embryos were of good enough quality to use. Sally said, ‘We’re only going to do this once, so put them both in.’ We were disappointed that we had none to freeze, but hopeful. When Sally called on the morning of the pregnancy test, to say it was positive, I was so excited that I ran around the hall screaming. I had to force myself to calm down, to remember it was still early days. Sally had a lot of nausea, which she hadn’t had in her two previous pregnancies, and I worried it might be a molar pregnancy. It was hard enough letting someone else carry the baby, let alone worrying that I might have made her ill too. The clinic reassured me that they only transfer normal-looking, healthy embryos, but it wasn’t until the three of us went to the first scan, at nine weeks, and we saw a heartbeat, that I relaxed. All through the pregnancy Sally made sure we were involved in all the scans and appointments. Later on, the only thing I couldn’t bear to do was to feel the baby kick. A kick was too much of a wrench, a reminder that the baby should have been inside me. I’d assumed I’d be able to take the baby home straight after the birth, but the hospital said that wouldn’t be possible because the birth mother, Sally, would, at that point, be the legal mother. So the baby would have to stay with her in hospital until they were both discharged. But, they said, I wouldn’t be able to stay in hospital too. As we couldn’t become the legal parents until we got a parental order — which we couldn’t even apply for until six weeks after the birth — we were stuck. I asked, ‘So who’s going to look after the baby, because Sally certainly doesn’t want to.’ Sally backed me up, and that’s when we spoke to Natalie Gamble, a solicitor who specialises in fertility. Legally, the hospital’s decision was right, but Natalie said there was usually a pragmatic way to sort these things out without breaking the law. After some negotiation, it was agreed that I could pay for a room in the hospital for me and the baby until Sally and the baby were discharged. After that, the hospital would no longer have any say and I’d be able to take the baby home. I was incredibly anxious leading up to the birth. How would we all feel once the long-awaited baby finally arrived? How would Sally feel when the baby came to us? How would the baby respond to us, having been inside Sally for nine months? And how would we thank Sally for giving us the most amazing gift anyone could possibly give? As it turned out, the day was one I will treasure for ever. The baby was born by C-section, as Sally had wanted. Straight away, the nurse came over and gave her to me. It was such an amazing moment. Neither John nor I minded if she was a boy or a girl, as long as everyone was well. But seeing her beautiful little face just made me melt with joy that we had a precious little girl. The first thing Sally said was that she was beautiful, then she told me to take Ellie to see her daddy, who was waiting outside. What could I say to that? Thank you didn’t even come close. We had to stay in hospital until Sally was discharged. Ellie and I had a private room at the opposite end of the ward to her. The next day, Sally knocked on the door and asked if she could have a cuddle with her niece, which was lovely. Those first three days in hospital, I couldn’t take my eyes off Ellie. I know I’m biased, but she is beautiful. It was wonderful just to sit there, holding her, and to be a mum. I hadn’t wanted to stay in hospital, but it was good for us to have that quiet time together, just Ellie and me, to get to know each other. To become Ellie’s legal parents, we had to apply to the court for the parental order. An official came to our house to talk to us about how she was conceived, how we felt, if the family had accepted her. One of the things we told her was that our friends and family were amazing at welcoming Ellie into the world. Everyone loved her just as if she’d grown inside me. I do think it must be hard for Sally. Even though she’s an auntie to Ellie, she’s kept in the background for the nine months since she was born. Maybe she doesn’t want to be seen to be getting too close. I think it must be emotional for her, but we haven’t spoken about it. We gave her a massive bunch of beautiful flowers, with a note from Ellie saying, ‘Thank you for looking after me for nine months’. ‘Thank you’ doesn’t seem good enough, but what else is there to say? I can’t remember what life was like before Ellie. Even the sleepless nights haven’t bothered me. It’s such a joy to see her growing into a wonderful little person. John adores her too and her little face lights up when he walks in from work. I don’t dwell on the cancer, or the fact I had to have a hysterectomy. I have a big scar, which runs from hip to hip, but it doesn’t upset me. Of course, I would rather have carried my daughter myself, but I have tried to keep that in perspective. We’re going to tell Ellie how she was conceived, as soon as she can understand it. We want her to know how special she is, and if she chooses to tell people in the future, that’s up to her. Конец ознакомительного фрагмента. Текст предоставлен ООО «ЛитРес». Прочитайте эту книгу целиком, купив полную легальную версию (https://www.litres.ru/brigid-moss/ivf-an-emotional-companion/?lfrom=688855901) на ЛитРес. Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro, со счета мобильного телефона, с платежного терминала, в салоне МТС или Связной, через PayPal, WebMoney, Яндекс.Деньги, QIWI Кошелек, бонусными картами или другим удобным Вам способом.